Francis Report: Update and Response

Jeremy Hunt Excerpts

Wednesday 11th February 2015 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With your permission, Mr Speaker, I would like to make a statement on the Government’s response to today’s report on NHS whistleblowing by Sir Robert Francis, and on progress to date in implementing previous recommendations from his public inquiry into the failures of care at Mid Staffordshire NHS Foundation Trust.

I asked Sir Robert to carry out a follow-up review because of my concerns that, despite good progress in implementing his original recommendations, the NHS was still not making fast enough progress in creating an open and transparent culture in which staff feel supported to speak out on worries about patient care. As a result, I was concerned that changes are still necessary if the NHS is to protect patients properly by adopting a transparent, no-blame, learning culture as is common in other sectors such as the nuclear, oil or airline industries.

Sir Robert has confirmed the need for further change in his report today. He said he heard again and again of horrific stories of people’s lives being destroyed—people losing their jobs, being financially ruined, being brought to the brink of suicide and with family lives shattered—because they had tried to do the right thing for patients. Eminent and respected clinicians had their reputations maligned. There are stories of fear, bullying, ostracisation and marginalisation, as well as psychological and physical harm. There are reports of a culture of “delay, defend and deny”, with “prolonged rants” directed at people branded “snitches, troublemakers and backstabbers”, who were then blacklisted from future employment in the NHS as the system closed ranks.

We of course recognise the high standards of care day in, day out in much of the NHS, and we know that many staff feel supported in raising concerns about patient care, with many dedicated managers going out of their way to address those concerns. However, the whole House will be profoundly shocked at the nature and extent of what has been revealed today. The only way we will build an NHS with the highest standards is if the doctors and nurses who have given their lives to patient care always feel listened to when they speak out about patient care. The message must go out today that we are calling time on bullying, intimidation and victimisation, which have no place in our NHS.

Before outlining the Government’s response to today’s report, I want to update the House on the progress made in implementing previous Francis recommendations. I have today laid in the House of Commons Library a report showing progress on all 290 recommendations originally made by Sir Robert, as well as the progress made in implementing other recommendations by Professor Don Berwick on safety, by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart in their complaints review, by Camilla Cavendish in her work on health care assistants and by the NHS Confederation on reducing bureaucratic burdens. The progress was recognised this morning by Sir Robert, who said that the priority that must be given to safety, compassion and quality of care is now better recognised and acted on.

I want to highlight the impact of Professor Sir Bruce Keogh’s review of hospitals with high mortality rates. The special measures regime that followed introduced the toughest and most transparent hospital turnaround regime anywhere in the world, with 19 hospitals—more than 10% of NHS acute trusts—having been put into special measures so far. Among the vast array of improvements since the start of the process, those trusts have recruited 109 additional doctors and 1,805 additional nurses, and have made 129 board-level changes. The independent research company Dr Foster estimated this week that excess deaths in those trusts had fallen by 450 in less than a year. That means that between them, they may have saved as many lives as some estimated were tragically lost at Mid Staffs between 2005 and 2009.

We have moved from a system that tolerated or denied high mortality to one that, while it is by no means perfect, seeks out problems, shares them with the public, takes action and saves lives. Today I can announce that the Care Quality Commission, Monitor and the NHS Trust Development Authority have published a new memorandum of understanding to enshrine and further improve the special measures process.

The other measures that we have introduced include giving the CQC, under its new leadership, legal independence and the legal powers that it needs for its chief inspectors to root out failure and highlight excellence. The chief inspector of hospitals has inspected more than half of acute trusts and will have inspected them all by the end of the year.

We have introduced criminal sanctions for those who wilfully neglect patients and those who provide false or misleading information. The new duty of candour for institutions and professionals means that when mistakes are made, patients or their families must be told. Fundamental standards are now in place to ensure that all providers are required to treat people with dignity and respect. All acute hospitals are now asking patients if they would recommend the care that they receive to friends or members of their family. That is being rolled out to other parts of the NHS, including primary care. Two thirds of hospitals are now implementing the “name above the bed” initiative to ensure that hospital care is better joined up. More than 200 organisations have joined the “sign up to safety” campaign, which involves a commitment to halve avoidable harm and save 6,000 lives by 2017.

The entire NHS is now committed to patient-centred culture change as a key part of the “Five Year Forward View” plans that were put forward by NHS England last autumn. In that plan, we recognise the important point that safe care and efficient use of resources go hand in hand: doing the right things first time in health care saves lives and money.

In respect of whistleblowing, the Government have taken significant steps to protect NHS staff, such as enshrining the right to speak up in staff contracts, amending the NHS constitution, issuing joint guidance with employers and trade unions, extending the national helpline to social care staff, and changing the law to make employers responsible if whistleblowers are harassed or bullied by fellow employees.

Today, Sir Robert makes it clear that there is more to do, and I am extremely grateful to him and his team for their work. He sets out 20 principles and a programme of action. I confirm today that I accept all his recommendations in principle and will consult on a package of measures to implement them.

The recommendations include asking every NHS organisation to identify one member of staff to whom other members of staff can speak if they have concerns that they are not being listened to. Drawing on the inspirational work of Mid Staffs whistleblower Helene Donnelly, those “freedom to speak up” guardians will report directly to trust chief executives on the progress in stamping out the culture of bullying and intimidation that Sir Robert today says is still too common. We will consult on establishing a new independent national whistleblowing guardian as a full-time post within the CQC to review the processes that have been followed in the most serious cases where concerns have been raised about the treatment of whistleblowers.

Because too often the system has closed ranks against whistleblowers, making it impossible for them to find another job, I can announce today that the Government will legislate to protect whistleblowers who are applying for NHS jobs from discrimination by prospective employers. With Opposition support, those necessary regulation-making powers could be on the statute book in this Parliament.

We will provide practical help through Monitor, the NHS Trust Development Authority and NHS England to help whistleblowers find alternative employment. Those three bodies have agreed a compact for action on this issue, and will publish detailed arrangements later this year. We will ensure that every member of staff, NHS manager and NHS leader has proper training on how to raise concerns and how to treat people who raise concerns. As a vital last resort, the right of whistleblowers to contact the press with any concerns they have must always be safeguarded, although it should not have to come to that. Today I will write to every trust chair to underline the importance of a culture where front-line staff feel able to speak up about concerns without fear of repercussions. In addition, Monitor and the TDA will write to trust chief executives today to ask them to ensure that all managers discuss these issues as a matter of urgency with those who report to them.

There must be consequences for trusts that fail to develop a culture of openness, so today I am publishing consultation options to ensure that where hospitals are found to have knowingly withheld information from patients, the NHS Litigation Authority can impose financial sanctions such as reducing the indemnity it offers against litigation awards. The final decision on how we implement these recommendations will be made after proper consultation with NHS providers, whistleblowers and patient groups to ensure that we honour the spirit of what Sir Robert has recommended, and to avoid unnecessary layers of bureaucracy or financial burden. There is no reason for individual trusts not to get on with implementing Sir Robert’s recommendations right away, particularly in ensuring that staff have an independent person with whom they can raise concerns.

A further foundation of a safe and open culture is one where the NHS and the public have access to meaningful and comparable information about the performance of local NHS organisations. The new MyNHS website has already kick-started a transparency revolution by making the NHS in England the first health care system in the world to offer key, up-to-date safety information on every major hospital, including open and honest reporting, nurse staffing levels in every ward, and the number of falls and hospital-acquired infections. Some estimate that we have as many as 1,000 avoidable deaths in the NHS every month, so by the end of March 2016 the NHS will become the first health care system in the world to publish an annual estimate of avoidable deaths by hospital trust, based on case note reviews and the safety record of those trusts.

I will strengthen the accountability of trusts by asking the chair of every trust to write a letter to the Secretary of State by the end of May each year, outlining what measures they will be taking to reduce the number of avoidable deaths in their trust. In all cases we will make it clear that this is not a process of naming and shaming but one of learning and improving so that our NHS becomes the first health care system in the world to adopt system-wide the safety standards that would be considered normal in other industries. We must also better understand avoidable mortality outside hospital settings, and whether we can adapt the methodology to identify avoidable harm as well as avoidable death. I therefore announce today that the Department will fund a national study to establish the extent of avoidable death in community settings, and the feasibility of developing locally attributable death rates.

We will be taking steps to hard-wire transparency into the health and care system, and I am publishing a transparency architecture with plans for further information to be released on MyNHS. That will include comprehensive reporting on the friends and family test, data on residential care home admissions, and a new balanced scorecard on the work of CCGs and health and wellbeing boards. The Care Quality Commission and the National Information Board have confirmed to me that, starting this year, they will report annually and in public to the Secretary of State and the Health Select Committee on the progress of the transparency architecture, and on any recommendations about how we can improve it. The Secretary of State will report to Parliament annually on progress, and today I am publishing for consultation changes that will enshrine that right in the NHS constitution.

One of the biggest causes of poor care is when no one takes responsibility for a vulnerable patient and the buck is passed. That leads to greater costs and numerous personal tragedies as people are passed unnecessarily around the system. The “name above the bed” initiative has strengthened accountability in hospitals, as has bringing back named GPs outside hospitals, but there is still not enough clarity on the role of professionally accountable clinicians, particularly in community settings. Today I can therefore announce that the Academy of Medical Royal Colleges has agreed to develop guidelines for meaningful clinical accountability outside hospitals. It will publish its findings this spring, and before the end of the next financial year all CCGs will publish how many of their patients with long-term conditions are being looked after by clinically accountable community clinicians in the meaningful way the academy will define. Proper proactive care for our most vulnerable patients will not only reduce hospital costs but reduce avoidable harm and improve the quality of compassionate care.

We can fund the NHS with a strong economy, we can put in place new models of integrated care to support an ageing population and we can champion innovation, but if we do not get the culture in the NHS right, we shall never deliver the ambitions that everyone in this House has for our NHS. Today is about tackling that culture challenge head-on so that we build an NHS that supports staff to deliver the highest standards of safe and compassionate care and that avoids the mistakes that have led to both unacceptable waste and unspeakable tragedy. If we succeed, we will be the first country anywhere to put its entire health care system firmly on the path to eliminating avoidable harm and death. Our NHS deserves no lesser ambition, so I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I welcome the Secretary of State’s statement and his obvious commitment to improve the culture of tackling poor care in the NHS; there is plenty of common ground between us. We endorse the principles laid out in Sir Robert Francis’s new report and we will work with the Secretary of State to get new safeguards on the statute book in the remainder of this Parliament, as he requested.

It was the Labour Government who, in 1998, introduced the first legal protection for whistleblowers in the Public Interest Disclosure Act 1998, reinforced in the NHS constitution in 2008. Sir Robert’s new principles build on those foundations. We thank him and the review team for their work and praise every whistleblower who has had the courage to come forward.

Our shared aim must be to create a climate in which every NHS worker feels able to raise concerns and feels confident that they will be listened to, that appropriate action will be taken and that they will not face mistreatment as a result. Sir Robert’s report will help achieve that. We particularly welcome the call for whistleblowers worried about losing their jobs to be offered alternative employment and for training in whistleblowing for all staff. Those measures are overdue. Will the Secretary of State say more about how Sir Robert’s principles will be enforced across the NHS and about the timetable for implementation? Will he confirm that they will apply equally to all providers of NHS services, including voluntary and private providers?

That brings me to an issue of major substance not covered in Sir Robert’s report. As he points out, his remit did not apply to any form of social care. That is a major concern, given that it could be argued that some of the poorest care provided in England today is in social care settings or in people’s own homes. Only at the weekend, a BBC investigation found that one in five care homes for older people is failing to meet standards for safety. Should we not today, across this House, establish the firm principle that Sir Robert’s recommendations should apply equally to all places where people receive care?

Let me turn to the recommendation for an external organisation that staff can approach for advice and support. In response to the first Francis report in February 2010, I established an expert group to update whistleblowing guidance. It reported in June 2010, and the Secretary of State’s predecessor announced plans for a “safe and independent authority” to which staff could turn when their organisations were not acting on concerns. Will the Health Secretary say why that has not progressed since then and assure us that there will be no further delays now that Sir Robert has reinforced that recommendation?

Although I believe that the Secretary of State’s commitment to improve the culture in the NHS is genuine, he will no doubt be concerned by Sir Robert’s findings that it might have got worse in recent years. In his report, he said about the cases he examined:

“Many were relatively recent or current. This is not about a small number of historic high profile cases from a time when organisations might argue the culture was different. We had a significant number of contributions about cases in 2014.”

The report specifically references figures from the latest NHS staff survey, which shows that reports of bullying have increased from 14% of staff in 2011 to 22% in 2013. Over the same period, the percentage of staff who feel able to speak out about poor care or to report errors or near misses has fallen from 98% in 2011 to 94% in 2013. Those figures suggest that things are getting worse, not better. Will the Secretary of State explain why he thinks that is and whether he will investigate the reasons further? That underlines the importance of any moves to improve the culture being introduced in the right spirit and being supportive rather than punitive, so that they do not reinforce the wrong culture and have the opposite effect to that which the Secretary of State is obviously trying to achieve.

At the weekend, the Secretary of State proposed fines and jail sentences for failure to be open about poor care. Although we support his zero-tolerance approach, is he certain that how this is perceived on the ground will not create a climate of fear and have the opposite effect?

Those concerns also apply to the new inspection regime introduced since the Francis report. In advance of today, I was contacted by a whistleblower who works in a hospital about a Care Quality Commission inspection planned for later this month and about the growing practice of hospitals running mock inspection days in advance of the CQC’s arrival, as schools have come to do with Ofsted. The whistleblower’s letter states:

“I enclose a document that invites us for a mock inspection to show us what to do and say when the CQC comes. Is this the correct thing to do? I think not. I cannot reveal my name as I would be instantly dismissed. Can you help?”

I am sure that the Secretary of State will be as concerned as I am to hear that and I will forward the information to him this afternoon.

I turn now to the Secretary of State’s update on the Francis report on Mid Staffordshire. Both sides of this House supported Sir Robert’s original recommendations and we give credit to the Secretary of State for making significant progress with their introduction, but gaps remain where progress has not been made and that is a concern when standards overall in the NHS are recorded to be falling, not rising.

In particular, there is a long-standing need to reform the system of death certification which goes back to Dame Janet Smith’s inquiry into the Harold Shipman murders. I took a personal interest in that as a Minister on the back of concerns raised by my hon. Friend the Member for Denton and Reddish (Andrew Gwynne)and James Purnell, the former Member for Stalybridge and Hyde. I legislated for reforms of death certification in the Coroners and Justice Act 2009, which made provision for the independent scrutiny by a medical examiner of all deaths that are not referred to the coroner.

Following successful pilots, Sir Robert Francis reinforced Dame Janet Smith’s recommendation. Dr Suzy Lishman, the president of the Royal College of Pathologists, says that introducing these reforms will

“improve patient care whilst reducing harm and saving money”.

It will therefore be a cause of great concern to a great many people, not least the families of the victims of Harold Shipman, that those reforms appear to be stuck in the long grass. Chris Bird, whose mother Violet was one of those victims, recently told the “Today” programme that

“it is criminal that the Government is stalling on implementing something like this that could save lives.”

I have been informed by senior officials in the Secretary of State’s own Department that he personally is holding up this reform. Can he say whether that is true, and if so why? If it is not true, which I am prepared to accept, will he today set out a clear timetable for the introduction of this vital reform?

Alongside that, we need better arrangements in hospitals for reviewing case notes when patients have died, as the Secretary of State mentioned in his statement. Over the weekend, the Government announced plans to introduce an annual review from a sample of patients. Although that will help us to develop a more accurate measure of avoidable deaths than mortality rates, does the Secretary of State think it goes far enough? Should not the NHS learn from all serious failings? Will he give consideration to our suggestion that every death in hospital should be subject to an appropriate level of review?

We welcome the renewed focus on staff numbers since the Francis report, but we also remind the House that in the first three years of this Parliament almost 6,000 nurses were lost and, with record numbers of people in hospital, nurse-patient ratios have not kept pace with demand and there are fewer nurses per head of population now than in 2009-10. One of the problems with having made so many permanent staff redundant is that, post Francis, recruitment has been heavily reliant on agency staff. As Robert Francis warns today, that has made it even harder to get the culture right. We welcome the Secretary of State’s recent focus on nurse numbers, but will he concede that it was a mistake to cut staff so heavily? Will he back Labour’s plan to bring down the agency bill by recruiting 20,000 more nurses?

We welcome the progress made at some hospitals in special measures, but may I caution the Secretary of State on his use of statistics? Is he aware of the graph on page 8 of the Dr Foster report, which shows that mortality rates at the Keogh trusts fell faster between 2006 and 2010 than between 2010 and 2014? There was never a tolerance or denial of high mortality, as he seemed to suggest in his statement.

On openness and transparency more broadly, the Secretary of State will be aware that the King’s Fund delivered a damning verdict on the Government’s reorganisation, concluding that it had damaged patient care. That is consistent with a survey of NHS staff, which found that 69% said the reorganisation had harmed patient care, with only 3% saying it had improved. It is suggested that the Government’s own risk register on the reorganisation warned that reorganising the NHS at a time of financial stress would damage front-line care. So that any future Government can learn the lessons of the past few years, will the Secretary of State publish the risk register, as recommended by Sir Robert Francis?

In conclusion, as I have always said, the lessons from Mid Staffordshire need to continue to be learned if the NHS is to be what we all want it to be: the safest and best health care system in the world. The Secretary of State has today taken some important steps towards that goal, but I hope he will respond fully to the serious questions I have raised.

[Mr Hunt]

I welcome the broadly constructive tone that we have heard today. May I say, in that spirit, that I hope that that represents a change in substance from some of the other exchanges we have had on these topics? The right hon. Gentleman tried to vote down the legislation that set up the new chief inspectors and he opposed the holding of a public inquiry into Mid Staffs. If we are to have constructive agreement across the House, I do think we need to agree on substance as well as on tone. Let me just take the individual points he mentioned.

We are completely committed to death certification. That was recommended in the wake of the Shipman inquiry. The right hon. Gentleman’s Government took a very long time to do anything on this and we have been trying hard to do it. It is a complicated thing to get right. On the question of looking properly at avoidable deaths, I just want to say this. It is very difficult, when one looks at case notes, to work out whether a death was avoidable or not, but we think we have a methodology to do that. It is more difficult to relate that to individual trusts, but we want to try to achieve that as well. I was disappointed at the weekend that when we announced that, his response was that it was unambitious. Two weeks earlier, he had published Labour’s 10-year plan for the NHS, which did not actually mention reducing avoidable deaths at all. What we are proposing is the most ambitious thing that any health care system has proposed anywhere in the world, and I hope it will have his full support.

On the right hon. Gentleman’s comments about not generating a climate of fear, he is absolutely right; it is really important, in getting the culture right, to make sure that people are supported to speak out and that there is not, as an unintended consequence, the kind of bullying and intimidation that Sir Robert says is all too common today. I suggest to him that one of the reasons for that climate of fear has been over-dependence on top-down targets as a way of running the NHS. That is what has created the fear in managers that sometimes has led them to treat their staff in the wrong way. What would be very constructive would be a recognition from Labour that that top-down targets culture did go too far, and that we need to rely on transparency as a way of improving performance as a much better tool than endless new targets.

In anything we do—this is something else where I agree with the right hon. Gentleman—we must look very closely at making sure that we learn these lessons in the social care sector as well. That is particularly clear when we look at the scandal of what happened in Rotherham. That is why, when we introduced the new CQC inspection regime following the original Francis public inquiry, we did not just set up a chief inspector for hospitals but set up a chief inspector for general practice and for adult social care. We are now getting the same Ofsted-style transparent rankings of how good care is in care homes, and indeed in domiciliary care. I know that he, like me, is concerned about 15-minute care visits. I think those inspections will help to root out those problems.

With respect to nurse numbers, I really do think that is something on which, if the right hon. Gentleman wants to be constructive, he should commend the Government’s efforts. We have 8,000 more nurses in our hospital wards than we had four years ago. Of course, as a short-term response a lot of hospitals are employing nurses through agencies. That must only be a short-term response. We need proper long-term commitment to institutions, which we do not get with agency staff, but I commend hospitals that have said, “While we try and get enough staff in place for the long term we are not going to wait, because we need to make sure that patients are safe today.” They want to do what it takes to do that.

Finally, on the risk register, I simply remind the right hon. Gentleman that when he was Secretary of State he blocked the publication of the risk register. As a Minister, he said:

“This would inhibit the free and frank exchange of views about significant risks and…management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

More broadly, I just want to say this. There are many patients and whistleblowers looking at today’s exchanges and wanting to see constructive agreement on the way forward. I think we can get a measure of that. What they say they want is not just words, but actions.

As we put staff and patients first in England, will Labour do the same for patients in Wales and today commit to a Keogh review of high mortality hospitals, commit to a chief inspector of Welsh hospitals and commit to protect staff who speak out in Wales, as we want to do in England? Will he commit to putting right a top-down culture that prioritised the needs of the system over the needs of individuals? Will he, as we do, recognise that that is always the danger of treating the NHS as a political possession and not as a service for patients? Patients must always come first. Staff who want to do the right thing for patients should always be heard. Our NHS deserves nothing less.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

May I endorse the Secretary of State’s remarks on Wales, having seen it at first hand? Having seen at first hand a constituent who was a whistleblower, and how her career and her family life have been so badly affected after she did the right thing, I know that what the Secretary of State has done today will be widely welcomed.

On the Public Administration Committee, we took evidence from the CQC and others, and it became very obvious that there is still a major problem with complaints procedures for patients and their relations. Patients often tell me that they are afraid to complain about the way that they are being treated in whatever NHS establishment they are in. Is there some way in which the Secretary of State can ensure that there are clear instructions in all NHS establishments on how patients and their relations can raise their valid concerns without their worst fears being realised?

[Mr Speaker]

Order. The right hon. Lady, whom I know extremely well as a Buckinghamshire colleague, rather like Treebeard does not believe in unnecessary or undue haste, but if I could suggest to colleagues that questions could be pithy rather than too leisurely I think we would all profit from that. The same goes, of course, for the Secretary of State, from whom we expect characteristically pithy, succinct responses.

[Mr Hunt]

As indeed we learn from you, Mr Speaker.

I welcome the question from my right hon. Friend, who is a former Secretary of State for Wales. People will want to know that these lessons will be learned in Wales. In the original Francis response, we set out clear plans for the way in which hospitals should make it clear, in every ward of every hospital, how one can complain not just directly to the trust, but to independent external organisations, such as the ombudsman, if necessary.

[Frank Dobson (Holborn and St Pancras) (Lab)]

May I warn the Secretary of State not to think that because he has decided something and because a circular has been issued, something has happened? In 1998, against a lot of opposition, I insisted that the whistleblowing law should apply to the NHS. I also issued a circular banning the use of gagging clauses. As I said in my discussion with Sir Robert Francis on this whole issue, it clearly did not work.

[Mr Hunt]

I thank the right hon. Gentleman for what he did when he was Health Secretary. I am well aware that in the world’s fifth-largest organisation, nothing happens just because someone issues a circular, which is why some of what we have announced goes beyond what Sir Robert precisely recommended. For example, by publishing avoidable death rates by hospital trust, we want to make the energy for change come from inside trusts, not from their being told to do things by Ministers. However, I welcome what he did as Secretary of State, and I hope we can do some other positive things.

[Sir William Cash (Stone) (Con)]

May I commend my right hon. Friend for his nuts-and-bolts approach and Sir Robert Francis for what is clearly an extremely good report? My right hon. Friend will know that Helene Donnelly is a constituent of mine, and that I read out a letter from her in Westminster Hall when I called for an inquiry under the Inquiries Act 2005—an inquiry that this Government set up, despite its having been refused by the previous Government and successive Secretaries of State. Will he bear in mind the need to dismiss any chief executive who does not take account of lessons learned and the fact that anyone who puts a whistleblower at risk does not deserve to hold their job?

[Mr Hunt]

I thank my hon. Friend because without his work and that of some of his Staffordshire colleagues we would not have had a public inquiry into Mid Staffs in the first place. Helene Donnelly has been a great inspiration to everyone who has thought hard about this subject. She had the courage and guts to stand up for patients at Mid Staffs, and she experienced terrible bullying as a result, which is why I am delighted that she is helping us. In fact, I think she is the inspiration for Sir Robert’s recommendation on “freedom to speak up” guardians. My hon. Friend is absolutely right that managers and chief executives must be completely accountable for delivering on this agenda, but we also need to send a signal to them that success for a chief executive means more than meeting A and E or 18-week targets; it is about the quality and safety of patient care.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

May I support the suggestion from my right hon. Friend the Member for Leigh (Andy Burnham) to extend to social care the measures recommended by Sir Robert Francis? I know from my own casework how hard it is for a whistleblower in social care working for a small organisation to reveal issues of bad care. In addition, the Health Select Committee pointed out that many whistleblowers suffer in their careers, including in social care, lose their job and find it hard to find a new post, and it recommended that whistleblowers who are vindicated receive an apology and practical redress. Does the Secretary of State agree?

[Mr Hunt]

I agree with the hon. Lady’s argument. Just as poor care has been identified in hospitals, so we have seen terrible examples of things happening in residential care and of inadequate domiciliary care. It is more complex, because the delivery of social care is more diffuse, but one way to deal with this is through the proper integration of health and social care and the proper assessment of quality based on the entire package of care that people receive, not just in individual institutions but across the board. We are doing a lot of work on that.

[Andrew George (St Ives) (LD)]

Like others, I welcome the report, but may I urge my right hon. Friend to reconsider the issue of safe staffing levels on acute hospital wards? I know that Robert Francis pointed to issues of culture and standards, but those are areas of interpretation and disputation. If we had the measuring stick of safe standards, particularly where a ward has less than one registered nurse to seven acutely ill patients—the level recommended by the Safe Staffing Alliance—whistleblowers would be able to point to a clear failing and service risk, which is especially important if the Secretary of State is worried about avoidable hospital deaths.

[Mr Hunt]

The hon. Gentleman makes an important point, but I hope I can reassure him, because NICE has published guidelines on safe staffing levels, although they are different for different parts of a hospital: in intensive care, it is 1:1; for less severe illnesses, it is one nurse to eight patients; and in other parts of a hospital, it is one nurse to four patients. Those are all published, and I hope they will help whistleblowers in Cornwall and elsewhere.

[Valerie Vaz (Walsall South) (Lab)]

What support will the Secretary of State give to trusts to ensure that safe staffing levels are implemented, given that they might need extra resources?

[Mr Hunt]

We have protected—indeed increased—the NHS budget in real terms at the time of the biggest financial crisis since the second world war, so I think the Government have done what they can to make resources available. However, improving care is not always about money, and some hospitals manage to staff their wards safely and achieve financial balance. In fact, hospitals that practise safe care tend to be in a better financial position than ones that do not, so safe care and good finances actually go together.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I commend my right hon. Friend for his statement and thank Sir Robert Francis for his excellent report, which, as the Secretary of State knows, goes to the heart of the Public Administration Committee’s inquiry into clinical incident investigation. It comes as no surprise that we still have severe problems in the NHS. Perhaps the “freedom to speak up” guardian role needs to provide complete legal protection for people speaking up, immunity from freedom of information requests so that the information and the names cannot be exposed maliciously, and the capacity to investigate what is reported to them on a completely independent basis. We look forward to his giving evidence to our Committee.

[Mr Hunt]

I thank my hon. Friend for his interest in the issue of culture change, including at his local hospital, which I visited last week and where I was pleased to see a change in culture happening, despite some very severe problems. It is excellent that PASC is doing this inquiry, and his suggestions sound very worth while. We will consider them as part of our consultation—in fact I would encourage his Committee to submit them formally, to ensure that we give meaning to these “freedom to speak up” guardians.

[Grahame M. Morris (Easington) (Lab)]

I welcome the report by Sir Robert Francis and the Secretary of State’s commitment to changing the culture around the protection of whistleblowers—the Health Committee recently published a report making specific recommendations about such protections. May I draw the Secretary of State’s attention to the actions of the General Medical Council, which wrote to the employer of a whistleblower who gave evidence to the Committee after he had expressly stated that he was acting in a personal capacity in raising questions and providing evidence of financial inducements being paid by private health care companies to secure referrals?

[Mr Hunt]

I am happy to look into that case carefully, if the hon. Gentleman will supply me with the details.

[Mr Laurence Robertson (Tewkesbury) (Con)]

rose—

[Mr Robertson]

Thank you, Mr Speaker.

A good friend of mine, a consultant cardiologist, had his career ended and his life completely disrupted after he blew the whistle on the unnecessary deaths of patients at a hospital he worked at. It has taken him more than 12 years to win his case at a tribunal, and he still awaits compensation. These cases often manifest themselves in employment disputes, with trumped-up charges brought against the individual. What can the Secretary of State do to ensure that such things never happen again?

[Mr Hunt]

I add my congratulations to my hon. Friend, who makes an important point. The heart of the problem of whistleblowing is the confusion between employment law and patient safety. We need to divorce those two things and put in place a proper procedure to ensure that the right thing happens if someone raises a concern about patient care, and that it can be externally investigated to ensure that the trust did the right thing. Issues of employment law and someone’s professional behaviour should be pursued on a completely different track—those things are rightly and properly a matter for the courts. It is precisely because of the kind of issue he talks about that people are afraid to speak out. They worry that if they do, even if they win at an employment tribunal, they might never get a job again. For that reason, we welcome the shadow Secretary of State’s commitment to work with us and put on the statute regulation-making powers making it illegal for NHS organisations to discriminate against former whistleblowers.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

The Secretary of State and I spoke last week about the importance of the upcoming Kirkup report. Grieving families in my constituency want to be able to move on from the tragedies they have suffered and see proper change in the culture at Morecambe Bay. What happened was not right and is still under criminal investigation. Will the improvements the right hon. Gentleman has announced today be in place when the report is published, and does he agree that the response to it must be neither whitewash nor witch hunt? If he does, how can he help make it happen?

[Mr Hunt]

I thank the hon. Gentleman for the close interest he has shown in this issue and the constructive way in which he has engaged with families locally to try to get to the bottom of a really terrible tragedy. He puts it better than I could. We need to implement the recommendations in a tangible and real way so that something actually changes, but we do not want to do it in a way that has unintended consequences. That is why the focus of what Sir Robert is saying this time is not about new criminal sanctions. Although the law has a role—we changed the law on wilful neglect, for example—this is about creating a supportive culture through which people want to listen and learn when others speak out. Of course, if people do not, there should be sanctions, but that should not be the primary motivator.

[Sir Bob Russell (Colchester) (LD)]

I was pleased to be with the Secretary of State last Thursday when he visited Colchester general hospital—one of 19 in special measures—and I am sure he will want to join me in praising the hard-working medical and support staff for all they are doing. He referred in his statement to the “entire NHS” being “committed to patient-centred culture change”, and observed that no one takes responsibility for a vulnerable patient so that the buck gets passed. I suggest that Sir Robert Francis would do well to look at the silo mentality—the reality rather than the rhetoric—in the case of the Haven Project in Colchester, to which the hon. Member for Harwich and North Essex (Mr Jenkin) and I have drawn attention. That is a classic case where the reality does not match the rhetoric.

[Mr Hunt]

Yes, and I remember the conversation I had with the hon. Gentleman about that issue. I will look into the case carefully. I am not saying that the NHS culture is changing today, because I think it is a very long journey. That is why it is important to have cross-party agreement. This is something that will take decades to happen. If we look at the best hospitals in the world, in England or abroad, we find that they get their culture right over decades. We must understand that. Breaking down those silos, putting patients first and making sure that that is not compromised, whatever the external pressures—that is the heart of the matter.

[Diana Johnson (Kingston upon Hull North) (Lab)]

When Pauline Lewin, a whistleblower, came forward in Hull to raise concerns about the then chief executive, Phil Morley, she found herself subject to hostility and bullying and has not been able to return to work—despite corroboration from a damning Care Quality Commission report, an ACAS report that established bullying and an independent KPMG report on financial irregularities. Meanwhile, the chief executive has moved on to another such post, earning £170,000 a year. I listened carefully to what the Secretary of State said—that he was “calling time on bullying…and victimisation” in the NHS—so will he reassure me that that will apply to this case, which his Department is currently investigating?

[Mr Hunt]

I remember the good meeting I had with the hon. Lady and the former Secretary of State about that issue, which we are looking into. I hope she will understand that it would not be right for me to comment on that individual case, but let me say that it seems to exemplify exactly how things have gone wrong. That is why we need to look into it very carefully. We need to create a culture through which the management actually want to listen to their staff. I do not want managers to do so because of something I say; I want them to feel that they want it happen. It is as much about making sure that organisational priorities are correctly set from the centre, as it is about changing the law.

[Charlotte Leslie (Bristol North West) (Con)]

Culture change is a big tanker to turn, and senior managers under pressure from targets and headlines need significant sanctions and incentives to reveal rather than smother or downplay difficult truths. Doctors have the General Medical Council, although it needs improvement, but managers have no regulatory body to make them accountable. Will the Secretary of State consider doing something about that?

[Mr Hunt]

I thank my hon. Friend, whom I know has thought extremely hard about this issue. Indeed, we talked yesterday about getting the fit and proper persons test to work properly. It is still in the early stages, so it is difficult to assess whether it is having the impact we want. We certainly hope it will have some impact. There is an unfairness about the fact that a clinician as a chief executive of a hospital is accountable to the GMC as a doctor, whereas a chief executive who is not a doctor is not accountable. We actually want more doctors to become chief executives. On the whole, they do a really good job, and we should give further consideration to that.

[Clive Efford (Eltham) (Lab)]

It will take a great deal to change the culture. I have spoken to a senior hospital manager who would like to express his concern about the lack of qualified nurses, forcing him to advertise posts abroad. I have spoken to two A and E nurses who are concerned about the critical situations occurring at their unit every day. One of them has become an agency nurse so she can limit the number of hours she is forced to work. Then there is an ambulance worker who is concerned about the 12-hour shift and the lack of time he is given to clean his ambulance between dealing with patients. They would all like to come forward to express their concerns, but they do not feel that anyone above them would listen. What can the Secretary of State say today to reassure those people?

[Mr Hunt]

I can say that we are consulting on making a big change that would mean they would have someone independent in their organisations to whom they could talk and raise their concerns. They could say, “I want to say this, but no one is listening to me”. That is what Sir Robert Francis calls “freedom to speak up” guardians, whom he wants in every organisation. It is what Helene Donnelly is championing in her work. That is the way forward to address those concerns.

[Andrew Stephenson (Pendle) (Con)]

East Lancashire Hospitals NHS Trust was placed in special measures, following the Keogh review, in July 2013, and it successfully exited that regime in July 2014. The trust has employed an additional 201 nurses and nursing support staff and 26 more doctors since June 2013, taking the total increase since May 2010 to 391 additional nurses and 40 additional doctors. In January 2014, the Royal College of Midwives named the maternity services unit the maternity service of the year. Will my right hon. Friend join me in paying tribute to the dedicated staff at East Lancashire hospitals for working with the new tougher regime and turning my local hospital trust around?

[Mr Hunt]

I absolutely will. This is a great example, and I would like to thank my hon. Friend for the interest he has shown in this issue. For one hospital to have 390 more nurses over four years is remarkable. It may interest my hon. Friend to know that those numbers do not include agency staff, so if the hospitals have any such staff, they will be counted on top of those figures. This is a dramatic turnaround for the quality of patient care, which we all welcome. That just shows that if we get the incentives right from the centre, trusts do want to do the right thing. We did not instruct the trust to employ a single extra nurse; rather, we set up a new inspection regime and special measures regime, and what my hon. Friend said shows it has worked.

[Steve Rotheram (Liverpool, Walton) (Lab)]

I, too, welcome the report. In his statement, the Secretary of State committed to the view that the new measures are not about “naming and shaming”. Does he therefore agree with the Prime Minister, who said:

“Francis does not blame any specific policy. He does not blame the last Secretary of State for Health. And he says we should not seek scapegoats”?

[Mr Hunt]

I do not think we should seek scapegoats, but I do think we need to understand where policies have inadvertently led to the wrong outcomes. Sir Robert talks clearly about the dangers of an excessive focus on targets, which is one of the things that have driven the wrong culture. On that, I hope to get cross-party agreement.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

As my right hon. Friend will be aware, one reason why Basildon hospital came out of special measures so quickly is that under the new chief executive, openness and transparency are is encouraged at every level. Does he therefore agree that it should be incumbent on all of us to be open, transparent and honest? Why does he think the Opposition are tweeting that the numbers of doctors and nurses at Basildon hospital are down, when I have just checked with the chief executive and found that the reality is that the numbers are up?

[Mr Hunt]

It is very important that everyone uses the right figures. What has happened at Basildon hospital is an inspiration to other trusts in special measures. In just a few months, it moved from being in special measures to being rated “good” by the CQC. The trust has an inspiring new chief executive, Clare Panniker, who really does listen to staff. I have been there and been told by staff how they feel that they are being listened to. We all have an obligation to make sure that the right information goes out to local communities, so that they understand where things really are getting better.

[Derek Twigg (Halton) (Lab)]

Most, if not all, hospitals are very concerned about next year’s proposed 3.8% efficiency saving. They fear that it will have an impact on access to and quality of services, and hence on patient safety. In the spirit of the openness and transparency that we now want to see, may I ask whether the Secretary of State was aware of those concerns, and whether, if he was not, he will find out why?

[Mr Hunt]

I am glad to note that this is rapidly becoming one of the most open and transparent exchanges of questions and answers we have had in the Chamber. I am, of course, aware of trusts which say that they will find it difficult to meet stretching efficiency targets, but I would say to them that if they look at some of the safest hospitals in the world—such as Salford Royal in England and Virginia Mason in Seattle—they will find that they have the lowest costs. It is not a choice between cost and safety; better safety leads to lower cost.

[Mr Marcus Jones (Nuneaton) (Con)]

Will my right hon. Friend join me in welcoming the progress that has been made at George Eliot hospital since the Keogh review? The employment of 91 extra doctors and nurses has certainly helped, but does he agree that we cannot be complacent and must continue to root out bad practice wherever it exists, in a very open and transparent fashion?

[Mr Hunt]

Absolutely. I have visited George Eliot hospital, and observed a few beds in the A and E department. One of the most inspiring things about it is that it came out of special measures by developing a strong link with University Hospitals Birmingham NHS Foundation Trust—under the leadership of Dame Julie Moore—which enabled it to learn very quickly what changes were needed. The “buddying” of trusts in difficulty with high-performing trusts is one of the measures that have worked the best.

[Liz McInnes (Heywood and Middleton) (Lab)]

I am pleased that the report mentions support for the right of NHS workers to speak up. When I was a Unite workplace rep in the NHS, I spent much of my time giving support and advice to workers who asked about blowing the whistle on malpractice. Does the Secretary of State recognise the vital advisory and supportive role provided by trade unions in the NHS, and will the Government cease their attacks on trade union facility time?

[Mr Hunt]

I agree that unions have an important role, but this should not have to be about unions. Regardless of whether a hospital has unions, people should be able to contact someone independent if they feel that their concerns about poor care are not being listened to, and that person should be enthusiastic about listening to what they say.

[Jackie Doyle-Price (Thurrock) (Con)]

This morning I was contacted about a patient at Basildon hospital who was suffering from Parkinson’s disease and who, on asking for assistance to go to the toilet, was told by nurses that they were too busy, so he had to use his pad. He was left in some distress, and suffering from nappy rash. Does my right hon. Friend agree that, when we are developing a patient-centred culture in the NHS, such behaviour should not be tolerated?

[Mr Hunt]

I do agree, and I have had many discussions with my hon. Friend about how local health care services can be improved. It shows real courage to raise a concern about patient care at one’s own local hospital. Basildon is a fantastic hospital—it is very well run, and it has really turned a corner—but that does not mean it is perfect, as I am sure its chief executive would be the first to accept. It is possible to have a sensible debate about improving care while being honest about the problems. That is the big change we need to make, and my hon. Friend has given us an example.

[Sarah Champion (Rotherham) (Lab)]

I welcome the focus on whistleblowers and the support package, but the Francis report also said that patients’ complaints should be viewed as the canary for failing hospitals. What support is the Secretary of State giving to patients who make complaints, and can he reassure us that the hospitals and the Care Quality Commission will take the issue very seriously?

[Mr Hunt]

Yes. We have set out new guidelines. The right hon. Member for Cynon Valley (Ann Clwyd) helped us a great deal when we were looking into how to improve the NHS complaints procedure, in particular advising people about how to complain and ensuring they knew that they could talk to someone independent if they needed to. I try to look at a letter of complaint about something that has gone wrong in the NHS every day before I start my work, and I make sure that the trusts are aware of that.

[Martin Horwood (Cheltenham) (LD)]

Before Christmas, I alerted Ministers to attempts by Gloucestershire Hospitals NHS Trust to prevent a governor from expressing concern to the local media about the care of local people. Does the Secretary of State agree that gagging governors is also unacceptable, and that the new spirit of openness should apply to governors and board members as well as staff?

[Mr Hunt]

I do, and I think it important to bear in mind the role of the press as a last resort for whistleblowers. Many of the problems of which we are aware have come to light because people have spoken to the press, and that is to be welcomed, but I think we would all agree that it is a real shame if things have to reach that stage. We need a culture in which people are listened to straight away. That governor should have felt that he or she could talk to someone in the hospital who would do something about the problem, rather than having to go to the press.

[Kate Green (Stretford and Urmston) (Lab)]

The Secretary of State has said that trusts are becoming more transparent in relation to data, and of course that is welcome, but data alone may not provide full information for patients. In 2011, Trafford general hospital had very poor standardised mortality figures, but, thanks to the assiduity of my constituent Mr Dennis Wrigley, we now know that they were due to a recording error. How will the Secretary of State encourage trusts not just to provide raw data, but to contextualise the data and tell patients what they might mean?

[Mr Hunt]

I hope the hon. Lady will be pleased to know that we have now made it a criminal offence to supply false or misleading information, but let me respond to the broad point that she has made, because I think it is important.

The publication of data is indeed welcome, but we do not want it to cause the entire NHS to focus on gaming the system, or changing the way in which data are collected in order to make its organisation look better. The purpose of data is to identify issues. The CQC then makes rounded judgments on the performance of institutions, which are based not just on data but on visits and conversations with patients, doctors and nurses. I think that that system can provide us with the best understanding of how well those institutions are actually doing.

[Chris Skidmore (Kingswood) (Con)]

As the Secretary of State will know, my hon. Friend the Member for Bristol North West (Charlotte Leslie) and I wrote to him about Southmead hospital after a large number of our constituents had written to us about poor quality care there. Today the CQC published its report on North Bristol NHS Trust and Southmead, which states that the urgent and emergency services are inadequate and causing a

“serious risk to patients’ safety”,

and also states:

“Several staff told us they were ‘ashamed’ of the standard of care”

at Southmead.

I have just received a letter from the chief executive of North Bristol trust, which makes no mention whatsoever of the fact that Southmead A and E had been declared inadequate. Instead, she simply refers to

“some teething problems which are being dealt with”.

Does that letter not illustrate the overall culture problem in the NHS, namely that there is active denial among some chief executives who will not admit what is going wrong in their local hospitals?

[Mr Hunt]

I have not seen the letter, so I hope that my hon. Friend will understand if I do not comment on it, but I strongly agree with his broader point. Any chief executive or manager in the NHS needs to understand that the best way in which to reassure the public, and to reassure Members of Parliament who speak out for their constituents, is to be honest about the problems.

My local trust was the first in the country to be given an “outstanding” rating. When I last went to see its chief executive, I said that I had three constituency problems, and I raised all three of them with him. He said, “Yes—we were wrong on that one; we should not have done that; and we were wrong on that one.” One of the best trusts in the country was being totally honest about its problems, and wanted to do better. We need to make managers understand that that is the right thing to do, and that we will back them if they do it.

[Robert Flello (Stoke-on-Trent South) (Lab)]

Longton cottage hospital had to close because the local trust could not recruit enough nurses to ensure its safe operation, yet the Government slashed nurse training places. Now the Department refuses to release the secret KPMG report on “distressed” health economies. The people of Stoke-on-Trent deserve to know what is happening to their local hospitals and to local health care. The Secretary of State rightly says that we need to stop secrecy and have openness, but when will he whistleblow his Department’s own report? The Department is setting a very bad example when it comes to openness and transparency.

[Mr Hunt]

I will look into the issue that the hon. Gentleman raises, but let me deal now with the issue of nurse training places. The cuts began under the Labour Government, and we have been gradually reversing them. The main point, however, is that, in all parts of the House, there was a lack of understanding of the importance of safe staffing in wards before the Francis report, which is why successive Secretaries of State made mistakes in their projections of what was needed.

We have 8,000 more nurses in our hospital wards, including those at Stoke, and I hope the hon. Gentleman welcomes that.

[Andrew Percy (Brigg and Goole) (Con)]

The Secretary of State will want to congratulate North Lincolnshire and Goole NHS Foundation Trust on getting out of special measures and employing more nurses and doctors. On the issue of “freedom to speak up” guardians, will he ensure there is one in every hospital, because in my trust staff in the smaller hospital sometimes feel their voice is not heard by the two big district general hospitals, which are up to 60 miles away?

[Mr Hunt]

That is a very good point. I had a great visit to my hon. Friend’s local hospital and saw a knee operation which was quite gory but looked to me to be a very good example of safe care. He makes a good point and I will certainly feed into the consultation the idea that it should be easy to contact somebody who works in the same hospital or building, rather than someone who is a long way away.

[Mr Ronnie Campbell (Blyth Valley) (Lab)]

When I entered this House in 1987 I was put on a Select Committee for the parliamentary ombudsman, which dealt with the health service and complaints within it. In bad cases, we would bring chief executives, chief nurses and chairmen of the trust concerned before us. That was a good deterrent. Why not bring it back?

[Mr Hunt]

All these things should be looked at, but through the Select Committee on Health we do now get chief executives of trusts to be accountable to Parliament. The Public Administration Committee is looking at the role of the ombudsman to make sure that works as well as it can, and we should wait for its recommendations.

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

Following on from the question of the hon. Member for Barrow and Furness (John Woodcock) about Morecambe Bay trust, has the Secretary of State had a chance to look at yesterday’s “Better Care Together” future plans report by the trust, which finally puts to bed the wild allegations locally of hospital and A and E closures and also sets a road map for eliminating the pre-2010 deficit, provided we get some recognition of the difficult geography of our area?

[Mr Hunt]

I know geography is a big issue, and the driving distance between Morecambe bay and Lancaster is a big challenge for the trust. I will look closely at that report, and I think Members in all parts of this House would welcome a commitment to avoiding scaremongering about local hospital services in the run-up to the election.

[Glyn Davies (Montgomeryshire) (Con)]

I represent a constituency in Wales, and look with some envy at the commitment to openness and transparency on both sides of this Chamber, and indeed the commitment to transparency and openness throughout the NHS in England following the Francis report and the Keogh review. What discussions can my right hon. Friend initiate, perhaps with the Opposition, to introduce the same level of transparency and openness in Wales so that my constituents in Montgomeryshire can also benefit?

[Mr Hunt]

I think it is very simple—there is a lot of agreement between us about what needs to happen. I recognise that the shadow Secretary of State is not personally responsible for what happens in Wales, but his party is, and a Keogh review of high mortality hospitals, a chief inspector of hospitals for Wales and a commitment to the whistleblowing measures announced today would do a lot to allay the concerns of my hon. Friend’s constituents that the lessons about openness are not being learned across the border.

[Charlie Elphicke (Dover) (Con)]

Does the Secretary of State recall that the Care Quality Commission found that in East Kent hospitals senior management and the front line were disconnected, there were problems with bullying and harassment, and people would not say how things could be improved, including in terms of clinical risk? Does that not indicate that this is not just about whistleblowers, but that it is important that management sets a culture of openness, and listens and hears the staff voice?

[Mr Hunt]

My hon. Friend is absolutely right, and I thank him for his interest in his local hospitals and his campaign for them. In the end, culture comes from the top. When people start a job they look at the values of their direct line manager and they copy them, because they think that is what it takes to get on, and the line manager looks to the chief executive and the chief executive in the end looks up to the Secretary of State, so it is very important—[Interruption.] I grant that that may not be the best thing. It is important that right from the top we set the right example about these issues.

[Robert Halfon (Harlow) (Con)]

I thank my right hon. Friend for the work he has done on this and for his forthcoming visit to Princess Alexandra hospital in Harlow. Further to the question on trade unions, we have outstanding trade union representatives in the Princess Alexandra hospital and they do a huge amount of work on these issues. Can my right hon. Friend confirm that these guidelines will also include trade union workers, so that they are covered by his recommendations?

[Mr Hunt]

That is an interesting point and we should certainly reflect on it in the consultation. I am looking forward to visiting my hon. Friend’s trust in March. On many of the visits I have made to hospitals in special measures, which his hospital is not, I have met union representatives and they have an important contribution to make, because nine times out of 10 the real problem is that the people on the front line feel they are not being listened to, and when that is put right the other things start to be solved as well.

[Steve Baker (Wycombe) (Con)]

As a former airworthiness engineer, may I strongly endorse my right hon. Friend’s direction of travel? Will he confirm that Buckinghamshire Healthcare NHS Trust, having exited special measures after the Keogh review, has enjoyed a fantastic transformation, which I believe he saw when he visited Wycombe hospital?

[Mr Hunt]

I had a fantastic visit there. This was a hospital that, putting it bluntly, was one of the worst in the country, and it is now on its way to becoming one of the best. The motivation and excitement not just of the management team but also the staff there, were palpable, and I think a huge number of good things are happening. What has worked there is the sense that what we are asking of the hospital is the same thing that they want to deliver for their patients—safe, compassionate care—and that must remain the focus.

NHS Major Incidents

Jeremy Hunt Excerpts

Wednesday 28th January 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on what guidance has been issued by NHS England on declaring a major incident.

[The Secretary of State for Health (Mr Jeremy Hunt)]

As you know, Mr Speaker, I am always happy to come to the House to discuss the NHS, but today we have been brought here to discuss a local operational issue that, regrettably, the Opposition have tried to spin as part of their policy to “weaponise the NHS.”

As I said to the House earlier this month, a major incident is part of the established escalation process for the NHS, and has been since 2005. It enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.

The decision to declare a major incident is taken locally, and there is no national definition. We must trust the managers and clinicians in our local NHS to make these decisions and support them in doing so by ensuring that there is sufficient financial support available to help them to deal with additional pressures. The document that has been questioned this morning by the Opposition Health spokesman was issued by the local NHS in the west midlands. That was done to help its clinical commissioning groups to work with local NHS organisations to deal with the unprecedented pressures they have been facing this winter. The chief operating officer of NHS England, Dame Barbara Hakin, has said this morning that this was a local decision and neither the responsibility of Ministers nor the result of pressure by Ministers.

Let me finish by praising the NHS for coping well with the unprecedented pressures. Performance against the A and E standard improved to 92.4% last week, which is testament to hard-working staff, and this Government will support them, not try to turn their efforts into a political football.

[Andy Burnham]

In the first week of January, at least 14 trusts across England declared major incidents, including three in the west midlands. Official figures show that pressure continued into the second and third weeks of January, with only seven A and Es out of 140 meeting the Government’s target. There were ambulance diverts, and even an A and E closure, but no further major incidents were declared. On 7 January, when the Health Secretary was called to the House to answer an urgent question, he said:

“The decision to declare a major incident is taken locally—there is no national definition”—[Official Report, 7 January 2015; Vol. 590, c. 273.]

He has just repeated that now, and called this a “local operational issue”, but that does not appear to be entirely accurate. Let me quote from the guidance that was sent in the middle of January. It is headed “NHS England” and it states:

“Major incidents should be agreed with…the Director on call for NHS England”.

Will the Secretary of State now withdraw his earlier statement to the House and confirm that this decision is not purely local, in that it has to be approved by NHS England?

Let me turn to the impact that this has had on trusts. There are 17 enhanced criteria set out, including requirements that may cause serious time delays for trusts in an emergency. For instance, there is a requirement on the on-call CCG manager to visit the trust and undertake a review. Let me tell the Secretary of State how those new rules were perceived by senior managers. I shall quote from an e-mail sent by the head of operations at one trust, who said that the requirement had been

“introduced by NHS England to effectively stop trusts from calling a major incident…Our hands will be tied in most cases if they wish to call a major incident for capacity reasons”.

Is the Secretary of State confident that the new enhanced criteria are not unduly burdensome and will not cause unnecessary delays for a trust in an emergency situation? Is he satisfied that this guidance is consistent with good practice at national level and safe to be left in place?

The Secretary of State has used the word “local” many times today, and spoken of the only consideration being relieving pressure on hospitals facing severe demand. However, his claim that this matter is purely local is called into serious question right now by this 86-page document headed “NHS England”—[Interruption.] He says it is from the local team, but this is a regional function of the national body, NHS England. The local claim will not wash, I am afraid.

I will tell the Secretary of State what the guidance tells trusts to take into account. He says that it concerns only operational matters, but section 7.2.3 is headed “Politics”, and subsection (a) asks:

“Is there increasing involvement of senior command and control tiers, political involvement or excessive media coverage?”

Subsection (c) asks:

“Is there a risk of reputational damage?”

Does not this muddy the waters hugely? Will it not distract doctors whose sole focus should be on the emergency situation, and not on media and political considerations that should form no part of their judgment? If the Secretary of State agrees with me on that, will he today instruct NHS England to withdraw this guidance and issue more appropriate instructions to the NHS in the region? The NHS remains under serious pressure, and it needs the clearest of instructions based on what is best for patients. Will he act today, so as to leave the NHS in no doubt that that must be its paramount and only concern at all times?

[Mr Hunt]

In the right hon. Gentleman’s desperate desire to weaponise the NHS, I am afraid that Labour has sunk to new depths today. He said in the media this morning that the Government had put news management over patient safety. That is ironic coming from him, given that so many officials testified to Francis about the pressure they were put under not to come out with bad news when he was Health Secretary. Even the head of the Care Quality Commission was roasted because she wanted to publish details of the problems that were happening in the NHS under Labour and he did not want that to happen when he was Health Secretary. That news management stopped the moment he walked out the door, and those days are over.

As confirmed by NHS England this morning, this was an operational decision; it was nothing to do with Ministers. This was the local NHS doing its best to get good guidelines out in a tough winter. [Interruption.] It is a local decision. The right hon. Gentleman is the man who talks—he did not deliver this in office—a lot about integration. It is absolutely right that a local hospital should talk to the rest of the local NHS to check about the impact of any decision it makes on major incidents, to make sure that patients are treated safely—is he now saying to this House that local hospitals should not talk to the rest of the NHS? That is what these guidelines say. This was a period when we had 16 major incidents, but that number has gone right down because performance on accident and emergency is significantly—[Interruption.] This is the underlying point, because the reason we have fewer major incidents is that A and E performance has got better. This is the week when we discovered that public satisfaction with the NHS jumped five points last year. This is the week when NHS unions have put patients first by suspending their strike, and Labour focuses not on patients, but on politics. On patients, he did not want to talk about the Welsh ambulance service publishing its worst ever figures, although the Labour leader says that we should be looking at what is going on in Wales.

Let us be clear: where Labour runs the NHS we have double the number of people waiting at A and E; double the number of people waiting too long for ambulances; and 10 times the number of people waiting for their operations. We have seen Labour today in Wales and Labour before covering up around Mid Staffs, ignoring patients and weaponising the NHS for political advantage—has the right hon. Gentleman not proved today that Labour is still not fit to run the NHS?

[Dr Sarah Wollaston (Totnes) (Con)]

Our hard-working NHS staff and, more importantly, patients need to have absolute confidence that the Secretary of State will never lean on operational decision making in these circumstances and will always allow that decision making to take place at the appropriate local level, backed, if necessary, by national guidance.

[Mr Hunt]

My hon. Friend is absolutely right to say that. It is why many people in the NHS will be so astonished to hear the shadow Secretary of State, who presided over a culture where precisely that kind of leaning from on high happened, making it difficult for people to make those local operational decisions in the interests of patients, now trying to make a political point. This was a local decision and it was confirmed today that Ministers had no involvement in it, and Labour should stop trying to score political points.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

This Government caused confusion about decision making and accountability because of their reckless and expensive restructuring of the NHS. Now, to achieve what the Secretary of State wants to achieve, he has to resort to the sorts of measures we are discussing. We have had two major incidents declared in local hospitals in Salford in one week recently, and I have great concerns that this sort of guidance means that it is harder for clinicians to take the steps necessary to resolve the A and E crisis. They should not have to think about the issues listed in this document: politics and whether there is a risk of reputational damage. I do not want Salford Royal hospital and the Royal Bolton hospital thinking, “We can’t do this because of reputational damage.” This should be done entirely on the basis of clinicians’ reasoning.

[Mr Hunt]

That advice was issued in the west midlands, and not in Salford. The hon. Lady talked about the reorganisation. Well, that reorganisation means that we have been able to afford 82 more hospital doctors and 589 more nurses in her area, which is helping her constituents. Salford is one of the best examples of integrated care in the country, which is why any hospital declaring a major incident should think about the impact on the rest of the NHS locally. That is what the guidance says.

[Mr Peter Bone (Wellingborough) (Con)]

The shadow Secretary of State is a very honourable gentleman, but he might live to regret this political football stuff. In north Northamptonshire, my hon. Friend the Member for Kettering (Mr Hollobone), the hon. Member for Corby (Andy Sawford) and I are working together on local decisions about our A and E. Surely that, and not political football, is the way forward.

[Mr Hunt]

My hon. Friend is absolutely right. I have spoken to the chief executive of Northamptonshire county council and I have heard about the excellent integration of services that is now starting to happen between the local authority and the local hospital. That is the way forward. The guidance simply says that trusts must pay attention to the impact on the local health economy before they make a local decision. It is time that Labour stopped playing politics with something that they know is a disgrace.

[Grahame M. Morris (Easington) (Lab)]

Is the Secretary of State satisfied that the new guidance with its 17 criteria, to which my right hon. Friend referred, will not have the effect of making it less likely that NHS hospital trusts in the west midlands or in my region declare an emergency plan?

[Mr Hunt]

Declaring a major incident is the decision of the local hospital trusts, and that is right. But it is important that, before they make that decision, they should take proper account of the impact on the rest of the local health economy. That is what every responsible hospital wants to happen, and that applies to the hon. Gentleman’s area as well as everywhere else.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

Following the declaration of a major incident at the accident and emergency unit of Colchester hospital, we now await the Care Quality Commission report into that incident, which will be published very shortly. We want the report to tell the truth, but it is harder to tell the truth in a political atmosphere where there are people who want to gloat over these challenges to get votes.

[Mr Hunt]

My hon. Friend is absolutely right. I have spoken to the chief executive of the hospital, and I must say that she and her staff are doing a good job in turning around a very difficult situation. What they want is support. We have issued sensible guidance that tells hospitals that if they declare a major incident, they must take account of the impact on the rest of their local health economy. A responsible Opposition would support such guidance, and not to try to turn it into a political football.

[Valerie Vaz (Walsall South) (Lab)]

The Manor hospital had to declare a major incident due to inordinate pressure from the closure of Stafford A and E. That is not a local issue, but a national one. When will the Secretary of State provide the hospital with the extra money to absorb the closure of Stafford A and E?

[Mr Hunt]

I can reassure the hon. Lady that we have provided a huge amount of extra money to deal with the problems in the wake of what happened at the former Mid Staffs Trust. We are continuing to give every support we can to Walsall and Stoke and other trusts. We have more doctors and more nurses and major changes are happening. The problem in Mid Staffs went on for four long years, and we do not want to wait that time before sorting out the problems.

[Paul Burstow (Sutton and Cheam) (LD)]

Clearly, patient safety must be paramount. We must ensure that any guidance supports the ambition that exists on both sides of this House for a more integrated system that takes into account the capacity across the whole service. Does the Secretary of State agree that what we also need is clarity and certainty over how the NHS and social care will be funded over the life of the next Parliament so that we realise the ambition and potential of the Care Act 2014 and we deliver Simon Stevens’s NHS plan?

[Mr Hunt]

I totally agree with the right hon. Gentleman. I am sure, too, that he will agree with me that the best way to give the NHS certainty over funding in the future and the increase in funding that it needs to implement the five-year forward view is a strong economy, and it is only this Government who are able to deliver that.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

According to some statistics, I have more medics per square mile in my constituency than any other MP. I also have the University Hospitals Birmingham NHS Foundation Trust on my patch and a lot of people who work across the west midlands and in Birmingham. The Secretary of State’s operational guidance, as he has interpreted it, is not perceived in the way that he thinks it is. A and E consultants tell me that they are not just overworked and overstretched, but unsafe. If he thinks the guidance is purely operational without any political interference, will he follow the call of the shadow Secretary of State and say that he will issue a new set of guidance that makes that clear, because it is not how it is seen on the ground?

[Mr Hunt]

I have great respect for the hon. Lady, so I hope she will understand this: when people are worried about political influence over operational guidance, I do not then issue some political guidance. The only thing that I, as Health Secretary, say in respect of instructions going out is that patient safety must always be the priority, and that is what I have said time after time. But then the actual decision about whether to declare a major incident must be taken by people locally. Julie Moore, the chief executive of UHB, is fantastic and absolutely able to make those decisions, and those decisions should not be second-guessed by politicians.

[Sarah Newton (Truro and Falmouth) (Con)]

Does my right hon. Friend agree that it is really important to let NHS England’s local teams—in our case the Devon and Cornwall area team—make decisions with local leaders of hospitals? So many people in the north of Cornwall live closer to Derriford in Devon than they do to Treliske in my constituency. It is only right that NHS England staff closest to the clinicians make those decisions.

[Mr Hunt]

That is absolutely right, but Members on the two sides of the House hold different views. We believe in devolving power locally and we want local decision-making. We accept that that might mean that sometimes services are slightly different in one part of the country compared with another, but the benefit is that we do get that local knowledge. In the past few weeks, I have spoken to South Western ambulance service, which had particular pressures over Christmas, to ask whether there is anything we can do from the centre. What I want to ensure is that the decisions that keep my hon. Friend’s constituents safe are made locally, because they are likely to be better than any that I could make in Whitehall.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Secretary of State is very reassuring when he says that, under him, the NHS is free from political news management. If that is the case, why does he not free it from the constraints of election purdah, and allow these officials to get on with their jobs without having to second-guess the consequences of some of the decisions?

[Mr Hunt]

We are not in election purdah. The point is that during election purdah we will continue to publish the weekly A and E performances and other figures from the Office for National Statistics, and that has always been the system. But there is a difference between what is happening in the run-up to this election and what happened in the run-up to the previous election. This time, the CQC is free to speak up, without fear or favour, about the quality of care in every single hospital in this country, and it will continue to do so.

[Mr Marcus Jones (Nuneaton) (Con)]

The Leader of the Opposition and the shadow Secretary of State visited the George Eliot hospital on Monday. The Leader of the Opposition praised the hospital for its progress under this Government. If we consider that, and then look at the way the Opposition come to this House and make political point scoring their No. 1 aim, we can see not only that they are hypocritical but that they want to put politics before patients.

[Mr Hunt]

I commend my hon. Friend for the support he gives to his local hospital. I visited it and did part of a shift in the A and E department. This was a hospital that, under the previous Government, had one of the highest mortality rates in the country. We introduced a new special measures regime and independent inspections. Labour tried to vote them down, but the result is that that hospital has come out of special measures, forged a strong new partnership with UHB and gone from strength to strength. Things are getting better because we are being honest about poor care, and did not sweep it under the carpet.

[Mr David Winnick (Walsall North) (Lab)]

The Manor hospital in Walsall was one of the very first in the west midlands to have to declare a major incident—a level 4 incident. I visited the hospital and saw the number of people on trolleys waiting for more than four hours. I want to pay tribute to the dedicated staff at the hospital—medical and non-medical—for all that was done. But the Secretary of State should not minimise the situation that has occurred. He should recognise that it is a matter not of playing politics but of genuine concern for our constituents.

[Mr Hunt]

I entirely agree with the hon. Gentleman. He should be reassured that because of those real pressures, which I would never seek to minimise, we put in an extra £4.5 million of funding to his local area, paying for more doctors, more nurses, more community staff and more beds. As he says, we should congratulate the staff in that hospital on their work, and also recognise that, despite those pressures, they have made real progress in improving the quality of compassionate care for the patients in that hospital. They have been very well led by the chief executive, whom I have also met.

[Robert Halfon (Harlow) (Con)]

Last week, the hon. Member for Leicester West (Liz Kendall) came to Harlow and attempted to weaponise the local NHS and scare local residents. A day later an interview was published in which she said that she supported privatisation in the NHS. Does my right hon. Friend agree that the best way to help the Princess Alexandra hospital in Harlow deal with major incidents is to do what the Government are doing, with £5 million extra last year for our A and E, and £4 million extra to help the NHS this year?

[Mr Hunt]

Indeed, across the country we have put in £700 million, which has paid for 6,400 additional beds in the system. All that is possible because we have a strong economy and we can put extra funding into the NHS. What those people in my hon. Friend’s hospital want most of all is support from Members in all parts of the House, and not to see their efforts turned into a political football.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Does the Secretary of State agree that Calderdale and Huddersfield trust was, until 2010, one of the most successful trusts in the country? I have a letter embargoed, ironically until 1 pm today, telling me of serious financial problems—not a major incident—caused by the reforms that his Government have introduced in the NHS. I remind him that it is my job as a member of the Opposition to weaponise—to use as a weapon—the disgraceful policies that his Government have introduced that are destabilising and destroying the national health service in my town and constituency, and up and down the country. I am a member of the Opposition, I will use this as a political weapon, and I will do so until the election, which we will win.

[Mr Hunt]

I am afraid that the trouble is that there are just too many people on the Labour side who think exactly like that. I suggest that the hon. Gentleman go and talk to people working in Calderdale and Huddersfield NHS Foundation Trust and ask them whether they want him to use the NHS as a political weapon in that way. They have improved their performance over the past few years and are seeing more people within four hours—every year, 4,000 more people within four hours than when Labour was in office—and MRSA cases are down. There are 79 fewer clostridium difficile cases; 525 more people are treated for cancer every year; and there are 6,200 more operations every year. Those are real improvements making a real difference to his constituents. He should celebrate them, not try to run them down.

[Henry Smith (Crawley) (Con)]

East Surrey hospital, which is the A and E department that covers my constituency, not least because Labour closed Crawley hospital’s A and E in 2005, has not had a major incident. Can my right hon. Friend confirm that major incidents have decreased because of the extra investment that he has put into the NHS, in stark contrast to Labour-controlled Wales, which has cut the budget?

[Mr Hunt]

I have been to East Surrey hospital, which is a good example. It, too, has had its share of problems with care, but it has addressed them head on. Standards in the hospital are getting better, and it is encouraging to see that refreshing openness and honesty. We have put more investment into the NHS. Welsh patients are angry, because they can see that openness and transparency about results, combined with strong financial support, not cuts from central Government, lead to better service. Rather than try to create a political weapon in England, Labour should act where they can do something about it—in Wales.

[Rosie Cooper (West Lancashire) (Lab)]

I was recently told by staff in Aintree hospital on Merseyside that, in the interests of patients and patient safety, executives should have declared a major incident. Although the execs teetered on the brink, they feared the political consequences of making that decision rather than doing the right thing. What genuine help and advice can the Secretary of State give execs who face that situation on the front line and help them to do the right thing for patients?

[Mr Hunt]

If executives did not declare a major incident because they were worried about the political consequences, they were wrong, but I would have to be persuaded that they would do that, because every NHS executive I speak to wants to put patients first, with patient safety paramount. On the practical things that we are doing, there are 60 more doctors, and 41 more nurses since 2010, and £4.5 million to help them through this winter. We are doing a lot of practical things to help the NHS in the hon. Lady’s area through the winter.

[Andrew Stephenson (Pendle) (Con)]

Many major incidents have their roots in things that happened some time ago. Blackburn’s A and E department has been struggling to cope with demand since Burnley’s A and E department was downgraded under Labour in 2007—a decision that the right hon. Member for Leigh (Andy Burnham) defended several times in the House, including on 19 November 2009, when he said:

“‘This is saving lives; I will stand by it’”.—[Official Report, 19 November 2009; Vol. 501, c. 236.]

On behalf of the residents of Pendle, I urge the Secretary of State to take no lessons from Labour on the management of our NHS.

[Mr Hunt]

That is it, and that is why it is not working for the Opposition politically when they try to put the NHS centre stage. They can see people who downgraded or closed 12 A and E departments across the country during their time in office now coming to Prime Minister’s questions and trying to criticise this Government when similar things have happened. The answer on all these occasions is to put patients first, do the right thing for patients, be honest about the problems and sort them out, and that is what the Government are doing.

[Mike Gapes (Ilford South) (Lab/Co-op)]

The hard-working and dedicated staff at Barking, Havering and Redbridge trust, at King George hospital in my constituency and Queen’s hospital in Romford, know, because their trust is in special measures, that there has been a lot of reputational damage. On 5 January, elective operations were cancelled—in my personal case, at two hours’ notice; I was not the only constituent who had to go through that—because of A and E pressures in the trust. Can the Secretary of State explain whether hospitals in special measures have a special requirement so that they do not need to declare that they are in the position of hospitals that have made the decision to say that there is a major incident, or is it just coincidental that although operations were cancelled on a large scale on 5 January no major incident was declared at Barking, Havering and Redbridge?

[Mr Hunt]

I can confirm that there is no difference in any guidelines issued for hospitals in special measures and for hospitals not in special measures. This is a good example of a trust with deep, pronounced problems over many years. There was a terrible tragedy in 2007, I think, when someone gave birth sitting on a toilet seat. This Government have said that we are going to tackle those problems and put the trust into special measures. It has more doctors and nurses: 230 more hospital nurses in the past four years in that trust. We are making a real difference—we have a new management team—and I think that things are beginning to get better in that trust in a way that has not been the case for many years. I hope that the hon. Gentleman would welcome that.

[Stephen Mosley (City of Chester) (Con)]

The shadow Secretary of State called on the Secretary of State to intervene to stop political interference in the NHS. May I ask my right hon. Friend to ignore such siren voices and rely instead on local doctors and local health professionals to make the best choices for our local NHS?

[Mr Hunt]

My hon. Friend eloquently points out the great irony in what we have heard from the Opposition Front Bench. We do not want an NHS in which every single operational decision is made from behind the Secretary of State’s desk. We want to trust people on the ground. Why do we want to do that?

[Andy Burnham]

Politics.

--- Later in debate ---

[Mr Hunt]

Exactly. We do not want politics to get in the way of what is right for patients, which is what happened when the right hon. Gentleman was Health Secretary. It will not happen while I am Health Secretary.

[Mark Reckless (Rochester and Strood) (UKIP)]

Do we have sufficient measures, short of declaring a major incident, to help to relieve hospitals such as Medway, where there has been an ongoing problem of excessive waiting times at A and E?

[Mr Hunt]

Yes, we have other measures in place. At every stage, trusts should do what is right for patients. Sometimes they declare an internal major incident, sometimes it is an external major incident, but what is important is that they take account of the impact on the rest of the local health economy. At Medway hospital, which the hon. Gentleman mentioned, things are getting better. It has been through a difficult period. We have been honest about the problems, we have given it a lot of external support, and I hope that the news will continue to get better.

[Richard Drax (South Dorset) (Con)]

As we know, one cap does not fit all. That applies to the NHS as much as to anything else. In Dorset the clinical commissioning group is reviewing health services and looking for local solutions to local problems. Does my right hon. Friend agree that that is the long-term solution for the NHS, rather than politicians sticking their noses in where, frankly, they should not be?

[Mr Hunt]

I absolutely agree with that. What I will not do is go round the media and say that the problems that the NHS is facing in Dorset, as it faces everywhere, are due to the fact that the area is very rural, which is the excuse that we heard over the weekend from the shadow Health Secretary for the poor performance of the NHS in Wales. We want local solutions and the highest possible standards—what we can do is give guidance and funding from the centre and make sure that patients are always put first.

[Jack Dromey (Birmingham, Erdington) (Lab)]

In his attempt to gag hospitals over the growing accident and emergency crisis, the Secretary of State has sanctioned guidance that “we must avoid reputational damage”. Whose reputation? His reputation? Does the right hon. Gentleman not accept that his reputation on the national health service is damaged beyond repair?

[Mr Hunt]

I will take no lessons in stamping out news stories on poor care because I am worried about the impact on reputation. That is what happened when the shadow Health Secretary was behind my desk, and it was totally unacceptable. That is why we had a clutch of hospitals where poor care was swept under the carpet year in, year out because a Labour Government did not want bad news to come out in the run-up to an election. It was a disgrace and this Government are putting it right.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Two weeks ago I asked the Secretary of State about a comment that had been made to me by a senior clinician in Hull that the trust in Hull at Hull royal infirmary had been on internal major incidents on and off since December. The Secretary of State told me that that was not really an issue and that it was down to the trust, but the documents that have been produced today show that the real reason is that it is politically much more expedient to have an internal incident than to declare one externally and get all the bad publicity and reputational risk mentioned in the document to which my right hon. Friend the shadow Secretary of State referred to. That is the case, is it not?

[Mr Hunt]

Let me make two points to the hon. Lady. When I talk to the House about the number of major incidents, we make no distinction between internal and external incidents. We talk about them all as major incidents. There is no benefit, if one looks at it in that way, to Ministers from it being either an internal or an external incident. What matters is the right thing for patients. Rather than trying to politicise the issue and turning it into a political football, the Opposition should listen to Dame Barbara Hakin, chief operating officer of the NHS, who said clearly today that the decision was nothing to do with Ministers, they did not know about it and it was not taken at the request of Ministers. Labour should concentrate on supporting the NHS where it could do with its help—in Wales today.

[Chris Williamson (Derby North) (Lab)]

The Secretary of State singularly failed to answer the question from my hon. Friend the Member for Easington (Grahame M. Morris) when he asked whether it would be more or less likely that a major incident would be declared as a result of the new guidance. Clearly, if it is less likely, that is bound to have an impact on patient safety. Can the Secretary of State confirm whether this issue was raised in his meeting with NHS England on Monday?

[Mr Hunt]

It was not raised by NHS England on Monday because I did not know about this local guidance, as I had absolutely nothing to do with it.

[Clive Efford (Eltham) (Lab)]

Can the Secretary of State explain why in the incident response plan from NHS England there is an entire paragraph headed “Politics” under the principles for considering an escalation response? In the House on 7 January he said:

“The decision to declare a major incident is taken locally—there is no national definition”—[Official Report, 7 January 2015; Vol. 590, c. 273.]

However, the guidance issued in the middle of January says that major incidents

“should be agreed...with the Director on call for NHS England”.

If it is not political, the Secretary of State owes the House an explanation of NHS England’s involvement and the meaning of that paragraph.

[Mr Hunt]

The hon. Gentleman has quoted selectively; he has not quoted the whole guidance. If he looks at the whole guidance, he will see that it clearly states that a responsible trust, before it declares a major incident, which is its decision, must make sure that there is not going to be a negative impact on the rest of the economy, because patients must always come first. He is also not saying what Dame Barbara Hakin said this morning —that none of this guidance was anything to do with Ministers.

National Health Service

Jeremy Hunt Excerpts

Wednesday 21st January 2015 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

What utter, disgraceful nonsense! I will rebut every single thing that the right hon. Member for Leigh (Andy Burnham) has said.

This has been a tough winter for the NHS, and I first want to pay tribute to the hard work of staff on the front line who have been working exceptionally long hours in very challenging circumstances. What they want right now is practical help, a vision for the future and a sensible plan to get there—all of which this Government are delivering. They do not want to be turned into a political football. The public have noted that while Labour Front Benchers sometimes sound restrained in parliamentary debates, they are the opposite in the TV studios, where they do everything possible to whip up panic and a sense of crisis. That is not the behaviour of a responsible Opposition.

As NHS England and the King’s Fund have said, the NHS is coping well under real pressure and, in the words of Dr Cliff Mann, president of the College of Emergency Medicine, trying to weaponise it for political purposes is “toxic”. Indeed, Professor Chris Ham, of the King’s Fund, said this week:

“This is a long-term issue not to do with this particular government—the previous government faced many of the same challenges...patients who are really poorly will still get a very good and very quick service.”

[Angie Bray (Ealing Central and Acton) (Con)]

In contrast to what we have heard from the Opposition, will my right hon. Friend join me in welcoming the seven-day-a-week GP surgeries opening up across Ealing and Acton and the plans for the new walk-in health centre for Acton? Will he join me in condemning the Labour-led council’s decision last night to cut the public health budget?

[Mr Hunt]

That is the reality: there are new and improved services for the NHS up and down the country, but what we get from the Labour party in my hon. Friend’s constituency is scaremongering leaflets saying that hospitals are being closed when they are not. Labour should apologise for scaring very vulnerable people. It claims to stand up for them, but by scaring them it is doing the exact opposite.

[Mr Marcus Jones]

Unfortunately, the right hon. Member for Leigh (Andy Burnham) did not do me the courtesy of giving me a right of reply when he mentioned the walk-in centre in my constituency. Does the Secretary of State not think that it was completely irresponsible for the right hon. Gentleman to make such comments, given that the issue was raised by a whistleblower and that the information does not come from the clinical commissioning group that is considering walk-in centres in my constituency?

[Mr Hunt]

Exactly. My hon. Friend makes the point very well, and I will tell him something else about the hospital in his constituency. The George Eliot hospital was a failing hospital with very high mortality rates, and its deeply entrenched problems were swept under the carpet by the previous Labour Government, but this Government have turned it around and it is now a successful hospital. It is doing incredibly well because we faced up to the problems that Labour ignored.

[Angela Smith]

Sickness-related absence is going up around the country. In Barnsley, it has gone up by two percentage points in the past two weeks. A one percentage point increase equates to £1 million a year. Not only will that hit budgets, but it is a real sign that the NHS is under severe pressure.

[Mr Hunt]

The NHS is under pressure, so the hon. Lady will welcome the fact that Barnsley Hospital NHS Foundation Trust in her constituency has 34 more doctors and 74 more nurses, and that we are currently doing about 2,000 more operations every year for her constituents. Yes, there is pressure, but this Government are investing on the back of a strong economy so that we can put more money into the NHS and give her constituents a better service.

[Barbara Keeley]

rose—

[Frank Dobson (Holborn and St Pancras) (Lab)]

rose—

[Mr Hunt]

I am going to make progress, but I will give way later.

I want to look at the pressures that the NHS is facing, because the right hon. Member for Leigh asked about the direct causes. There are more than 1 million more over-65s than there were four years ago. Many older people become particularly vulnerable when it is cold, which is why winters are always difficult for the NHS. The truth is that over successive decades, we have made older people more dependent on emergency care by under-investing in primary and community care, reducing the responsibility of GPs for out-of-hours care, removing the personal responsibility for patients from GPs, and failing to integrate health and social care.

The right hon. Gentleman spoke as if that was nothing to do with Labour. However, he knows what damage was caused by the GP contract changes in 2004, he knows that his Government failed to integrate health and social care for 13 years, and he knows that where Labour runs the NHS today—in Wales—the performance is even worse. Instead of debating constructively, he chose to start this year by putting up a scaremongering poster that implied that the NHS would cease to exist if this Government were re-elected. That is not good enough. The whole country can see that, for him, it is not about the ward, but the weapon; it is not about the patients, but the politics. For this Government, it is about the patients.

[Mr Redwood]

Does my right hon. Friend understand Labour’s attack on privatisation? Under Labour, the NHS always had private-sector contractors as GPs— and nothing has changed; and it always bought all its pharmaceuticals from competitive, profit-making pharmaceutical companies—and nothing has changed. What is the shadow Secretary of State’s grievance?

[Mr Hunt]

Privatisation is one of the most pernicious fears that Labour is seeking to stoke up—not least because, as Secretary of State, the right hon. Member for Leigh allowed the decision to go through that Hinchingbrooke hospital should be run by the private sector. He has been running away from that decision faster than anything that anyone has seen before, because he is still trying to curry favour with the unions.

The companies on the shortlist for Hinchingbrooke hospital were Circle, Serco and Ramsay Health Care. He could have stopped that as Secretary of State, but he did not. He knows—[Interruption.] Those were the three bidders—the private sector-led bids. He could have stopped that process when he was Secretary of State, but he chose not to. That makes my point very well.

[Barbara Keeley]

The Secretary of State and the right hon. Member for Wokingham (Mr Redwood) asked what had changed. Under Labour, we did not have tendering for £1.2 billion of cancer and palliative care services, as we are seeing now in Staffordshire and Stoke, where the majority of those tendering are private companies. We did not have that.

[Mr Hunt]

What the last Government did, that was right, was to say that—[Interruption.] I am just saying what the last Government did right. The hon. Member for Worsley and Eccles South (Barbara Keeley) might want to hear this, because I do not usually compliment the last Government.

To bring waiting times down to 18 weeks, the last Government said that they would support the NHS by allowing the private sector to do some operations. We have continued that policy, not changed it. The result, the hon. Lady will be pleased to know, is that 6,000 more operations are happening every year in her constituency under this Government than in 2010.

For this Government, it is about the patients. That is why we increased the NHS budget; why we hired 9,000 more doctors and 6,000 more hospital nurses; why we are doing nearly 1 million more operations a year than four years ago, with fewer long waits than ever; why we have increased cancer referrals by half, saving an estimated 1,000 lives every single month; and why we have learned the lessons of Mid Staffs by putting in place safe staffing, having independent inspections and turning around six failing hospitals.

Patients say—[Interruption.] The right hon. Member for Leigh should listen to what patients say, because he did not do that when he was Secretary of State. Patients say that their care is safer and more compassionate than ever, with the independent Commonwealth Fund saying that under this Government, the NHS has become the best health care system in the world.

[Frank Dobson]

rose—

[Mr Hunt]

I give way to the former Secretary of State.

[Frank Dobson]

Will the Secretary of State confirm that the only reason why he has been able to recruit British doctors is that the previous Government increased recruitment into medical schools by 35%?

[Mr Hunt]

I welcome the fact that the previous Government increased training places, but as the right hon. Gentleman will know, having been Secretary of State, those doctors have to be paid for. The NHS budget has not been cut, as the shadow Secretary of State wanted, so we can afford to pay for those doctors. There are 219 more doctors serving the constituents of the right hon. Gentleman because of the decision that this Government took to protect the NHS budget.

Even more important than what we have done for patients in this Parliament is the fact that, under this Government, the NHS has developed its own plan for the next five years, the “Five Year Forward View”. Because we have a strong economy, we can back that forward view with a record £2 billion extra for the NHS front line next year alone.

Part of our commitment to the NHS—this is a real difference between the Government and the Opposition—is that we face up to difficult decisions, including on pay. No one wants to be more generous to staff who work long hours than I do, but the official advice that I received as Secretary of State was clear: the cost of accepting the pay review body’s recommendation would be £450 million, which would mean that hospitals might lay off between 6,000 and 14,000 nurses.

It is easy for Labour to support a pay strike, but it is deeply cynical if it cannot pay for its promises, as it knows it cannot. Labour claims to stand up for staff, but will it today stand up for patients by condemning the strike right in the middle of winter, which was supported by only 4% of NHS workers, or do the votes and financial support of the unions matter more? The test of a party that aspires to govern is not the easy decisions that it makes, but the tough ones. We have seen nothing brave or principled from Labour today.

[Andy Burnham]

I have a direct question and I would appreciate a direct answer. If the agency bill in the NHS was the same as the one I left behind, would not the Secretary of State be able to afford the modest, below-inflation increase that the Chancellor promised to all NHS staff?

[Mr Hunt]

Let me tell the right hon. Gentleman why the agency bill has gone up. It has gone up because hospitals are trying to recruit doctors and nurses to tackle the problems of Mid Staffs that he left behind. As they improve their staffing, they will gradually get more full-time nurses, but in the short term, they do not want to put patients’ lives at risk.

I want to return to the situation this winter. To relieve the immediate pressures, we have given the NHS a record £700 million, which has allowed it to recruit an extra 796 doctors, 4,700 nurses and 3,094 other staff, making a total of 8,590 additional staff, and to increase bed capacity by 6,400. We have more staff, more beds, more GP appointments and more GPs in A and E than ever before for winter.

What is the impact of the extra support that we have given the front line? The target is to see and treat people in A and E within four hours. Compared with the last full year for which Labour was in office, 3,000 more people are being seen, treated and discharged within four hours every single day. The mean time that people wait for a first assessment has fallen from 77 minutes to 30 minutes, and nine out of 10 people, even under the pressure of the additional visits, continue to be helped within four hours. That performance is better than anywhere else in the United Kingdom—and, indeed, better than in Canada, Australia, New Zealand, Sweden and any other country in the world that measures A and E performance.

While the NHS is straining every sinew to meet high standards, the public will not accept the cynical politics that demands that we call it a crisis in England, while refusing to call it a crisis in Wales, where Labour is in charge and the problems are far worse. According to the House of Commons Library, in Wales, double the number of people are kept waiting in A and E, and nearly double the number of people wait too long for an urgent ambulance. For Labour, poor care matters only when there is a political point to be scored. For a party that aspires to run the NHS, that is simply not good enough. How Nye Bevan would turn in his grave if he knew that the party that founded the NHS was turning its back on patients with such contempt in his own back yard!

[Mark Field (Cities of London and Westminster) (Con)]

Although I appreciate that there will inevitably be a battle between the two parties to a certain extent in this debate, the Secretary of State is at his strongest—this is what I hear from all the health care professionals in my constituency—when he talks about his patient-centred vision for the health service of the 21st century and when he looks away from the here and now and towards the future that we all know is desperately needed by all our constituents: a patient-centred NHS. I hope that he will say a little more about that.

[Mr Hunt]

I will, and that is what this is about—putting patients first. That is why we need important reforms such as ensuring that every vulnerable older patient has a named accountable doctor—I will mention that later in my remarks—and why we must remove barriers between the health and social care systems.

[Sir Hugh Bayley (York Central) (Lab)]

It has been well known in the NHS for decades that an ageing population means that more needs to be spent in real terms each year on the NHS than in the year before. In 2010, when the Government came to power, 8.2% of our gross national income was spent on the NHS, but that has now fallen to 7.9%. How can that possibly be an increase in the Conservative party’s commitment to the NHS?

[Mr Hunt]

Because the only way we could return the economy to growth was by tackling the deficit left by the Labour party—the worst deficit in the developed world. Labour left us with that problem; we have sorted it out and are turning the country round. If the hon. Gentleman wants to increase spending on the NHS, as I do, the only way to do that is through a strong economy, which is what the Government are delivering.

[Several hon. Members]

rose—

[Mr Hunt]

Let me make some progress. In A and E, as everywhere in our hospitals, it is important that whatever the pressures, people are given safe, compassionate care. Our NHS is one of the safest systems in the world, but we still have around 1,000 avoidable deaths every month. We still put the wrong prosthesis on someone once a fortnight, operate on the wrong part of someone’s body once a week and leave a foreign object in someone’s body twice a week. Just five years ago, we had the tragedy at Mid Staffs, which, we should never forget—[Interruption.] I am quite shocked that people are laughing when we are talking about harm that happens in the NHS every month and about what happened at Mid Staffs. We must not forget that Mid Staffs was hitting its A and E targets for much of the period that that same department was tolerating the most horrific care. Whatever the pressure to hit targets, the Government want every vulnerable person to be treated safely and with the highest standards of dignity and respect.

Two years ago, we introduced the toughest inspection regime anywhere in the world. The result was over 6,000 more nurses on our hospital wards, cases of MRSA and clostridium difficile halved over this Parliament and more than 200 NHS organisations have signed up to halve avoidable harm and avoidable death over the next three years. Care is getting safer. While we lead the NHS through that painful process, what is the reaction from Opposition Front Benchers? They criticise us for running down the NHS and still maintain—as the right hon. Member for Leigh did in December—that it was a mistake to hold a public inquiry into Mid Staffs. He talked about listening to patients, but this is what Julie Bailey, a Mid Staffs campaigner whose mother was a patient at Mid Staffs said about his comments in December:

“The message he is sending out is that it is better to cover things up than to criticise the NHS, however bad things are. The inquiry uncovered huge failings in the NHS and he thinks it shouldn’t have taken place at all. It is very worrying because if he becomes Health Secretary again at the election it is clear we would go straight back to the bad old days of covering up.”

[Bob Stewart (Beckenham) (Con)]

One problem last month in my local hospital, the Princess Royal university hospital, was the lack of space, and ambulances were backed up. It is not just a staffing problem; it is a spatial problem. Does the Secretary of State agree that if we had more space in A and E departments, we could get people off the streets?

[Mr Hunt]

Space is a problem in some A and Es, which is why we have expanded A and E capacity. Other places have different problems, but the long-term solution is to have improved capacity outside hospitals in community care. That is the real challenge and what the “Five Year Forward View” is about.

[Andy Burnham]

Given what the Secretary of State has just said, may I gently remind him that I was the Secretary of State who appointed Robert Francis QC to inquire into what happened at Mid Staffs, against the advice of the Department of Health, and that report was published before the last election. If he is being fair, he should bear that in mind at all times.

The Secretary of State reeled off a list of things that are wonderful in the NHS today—everything has got better; everything is fine; and it is the best in the world. At the beginning of the debate, I reeled off cases of people waiting hours or even dying while waiting for ambulances, or being treated in cupboards. I hope that he will not conclude his remarks without addressing the very real suffering and poor care that is happening across England right now.

[Mr Hunt]

If the right hon. Gentleman did such a wonderful job and wants to talk about Mid Staffs, why are patient campaigners so outraged by his comments and feel that he did everything he could to brush those problems under the carpet?

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I will give way to the former Secretary of State in a moment, but I want to finish—[Interruption.] Exactly. I have read the Francis report and I have acted on it. [Interruption.] I have just listed what we have done: £700 million, 4,700 more nurses and 800 more doctors.

[Andy Burnham]

It’s not working.

[Mr Hunt]

But the right hon. Gentleman’s constituency has more doctors and more nurses who are seeing more people every year within four hours and doing 4,000 more operations every year. That is working for his constituents, but there is pressure out there and we need to support people through a difficult winter.

The right hon. Gentleman mentions stories that are, of course, very tragic, but never once has he brought up stories about the problems happening in Wales. Too often, we get the impression that, for Labour Members, poor care under a Labour Government—whether in Wales today or Mid Staffs previously—does not matter as much as poor care under this Government when they can make a political point. A party that really cared about the NHS would be as outraged about problems when they are in power as they are when in opposition. For this Government, poor care is poor care, and we will deal with it wherever and whenever it happens.

[Alan Johnson]

Does the Secretary of State remember the words of the Prime Minister when he stood at the Dispatch Box and presented the report from Stafford? He said that what happened at Stafford was not the fault of any previous Secretary of State, including my right hon. Friend the Member for Leigh (Andy Burnham). The Prime Minister was a statesman on that occasion; it is a shame that the statesmanship has slipped since.

[Mr Hunt]

I have a great deal of respect for the former Secretary of State, but if he had followed the debates on Mid Staffs in this Chamber he would know that my disagreement with the shadow Health Secretary is over the reaction to Stafford and whether we will learn from those mistakes. When I have made speeches talking about the problems of poor care in the NHS today, he goes straight out to the TV studios and says that that is running down the NHS. That is not acceptable when we are taking difficult decisions to turn round failing hospitals and face up to problems in exactly the way suggested by the Francis inquiry.

[Several hon. Members]

rose—

[Mr Hunt]

I will make some progress because I want to answer some of the questions asked by the right hon. Member for Leigh. One reason for the pressure I have outlined is that people increasingly expect to get medical care 24/7, just as they are able to bank, shop and book their holidays 24/7. The NHS cannot be King Canute and try to stop that—I am not blaming patients, but that is how patient expectations are changing, and we need to give them better alternatives to turning up in A and E.

Over the past two years, we have expanded weekend and evening GP appointments for more than 5 million people. We have also rolled out the 111 service, which now handles—these are the facts—three times more calls every year than its predecessor, NHS Direct. The right hon. Gentleman criticised 111, so let us look at the facts. Of those who call 111, 30% say they would have gone to A and E but decided not to as a result—that is 2 million journeys to A and E and around 600,000 ambulance call-outs avoided because of 111. Unlike NHS Direct, one third of all 111 centres can now access a summary of people’s GP records, and that will apply to nearly all 111 centres this year. Not only can people talk to a doctor or nurse, as they did with NHS Direct, but if they give consent they can do something that they could never do under NHS Direct and talk to someone who knows about them and their medical history.

Another big challenge facing A and Es is the increasing complexity of the illnesses that people are presenting with, including many older people with conditions such as dementia, diabetes or asthma. Such people often end up being admitted to hospital rather than treated and sent home, and that is not just challenging for the system; it is often wrong for the individual. A busy A and E can be the worst possible place for a frail, older person with dementia, which is why in our vision for the NHS every vulnerable person has a doctor who is continually responsible for their care, whether or not they are in hospital, and who ensures that they have proper care wrapped around them, thereby reducing the likelihood of emergency hospital admissions. Too often, that does not happen. Too often, the buck stops with no one. That is why, this year, we reversed the 2004 decision and brought back named GPs with personal responsibility for everyone aged 75 and over. That is helping 4.5 million people. With 800,000 of the most vulnerable people, we are going even further, giving them guaranteed rights to prompt and proactive care from their GP.

On social care, for too long, some of the most vulnerable people in our country have suffered from disjointed care with NHS and social care systems that, rather than talk to each other, constantly try to pass the buck. For the first time from this April, we have required all local authorities and NHS organisations to work together to plan care in a joined up and seamless way, as part of the better care programme.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make progress.

When that happens, we should see, for the first time ever, not an increase but a reduction in emergency hospital admissions. For patients, that will mean something important: a doctor or nurse will be in charge of every person in the social care system; medical records will be shared, so that people get safer and more joined-up care; and joint teams will work together across the NHS and social care systems, rather than the silos and boundaries that have plagued the system till now.

The Government have never pretended that the challenges facing the NHS are straightforward, but with more doctors, more nurses, more operations and safer care than ever before, we have shown our commitment to that most precious institution. We have put our money where our mouth is, with protection for the NHS budget during cuts, financial help this winter and support for the NHS’s plan for the future. More important than the money are the values behind it: our passion for the highest standards of compassionate care for every person who needs the NHS. Good care, not clever politics, is the future for our NHS.

[Several hon. Members]

rose—

Ambulance Service: England

Jeremy Hunt Excerpts

Friday 16th January 2015 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today I am announcing that NHS England is to pilot a possible change to the way ambulance services respond to 999 calls, based on clinical advice that this will improve the chances of survival for patients, especially those with the most serious conditions.

In light of the unprecedented increase in demand for ambulance services in the last two months, I asked NHS England to consider whether there were any changes which could be brought forward quickly in order to help ambulance services maintain, and perhaps even improve, clinical outcomes for patients.

I have now received and considered NHS England’s advice. A copy of the letter from Professor Keith Willett, the National Director for Acute Care at NHS England, with his recommendations, is attached and has been placed in the Library of the House. I agree with his advice that there is significant evidence to suggest that giving call handlers extra assessment time to make the right decision for the patient could improve clinical outcomes and improve their chances of survival. At present, ambulance services are allowed only 60 seconds before the clock starts to decide what the right course of action is for that individual patient. This sometimes leads to ambulances being dispatched unnecessarily, so that fewer ambulances are available for patients who really do need emergency assistance.

In the interests of patient safety, I therefore agree that giving call handlers very limited extra assessment time would ensure that ambulances are better deployed to where they are most needed and would allow a faster response time for those patients who really need it.

I have agreed to two local pilots where call handlers will be allowed up to a maximum of an additional 120 seconds for assessment, before the clock starts, for all 999 calls. This will not include those calls which are immediately life threatening (categorised as Red 1 calls). The pilot will therefore allow for a maximum of 180 seconds to assess a call, in order to reach a more detailed diagnosis and send the most appropriate response.

In these pilot sites, a small number of potentially life threatening conditions, such as overdoses and certain types of gunshot wounds, will also be upgraded from the Red 2 category into the Red 1 category so they receive a faster response than is currently the case.

The two pilot sites will be South West Ambulance Service NHS Trust and the London Ambulance Service NHS Trust—one running the NHS Pathways triage system and one running the Advanced Medical Priority Dispatch System. The pilots will start in February and will jointly cover a patient population of around 13 million people.

During the pilot, ambulance targets for all other areas will not be changed. We will continue to publish national data as normal, and the pilot data will be published alongside this in the interests of transparency. Given the pilots will only be affecting two ambulance services for a very limited period of time at the end of the reporting year, we do not anticipate that this will have a significant impact on the overall national data.

The pilot will be subject to rigorous and independent external evaluation which will be published. I will not support any extension of this pilot more widely unless the following three tests are met:

There is clear clinical consensus that the proposed change will be beneficial to patient outcomes as a whole, and will act to reduce overall clinical risk in the system.

There is evidence from the analysis of existing data and piloting that the proposed change will have the intended benefits, and is safe for patients.

There is an associated increase in operational efficiency. The aim is to reduce the average number of vehicles allocated to each 999 call and the ambulance utilisation rate.

After the evaluation has been published, I will consider the outcomes of the three tests and the findings of this external evaluation before making any decisions to implement these changes throughout England.

The letter from Professor Keith Willet can be viewed online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2015-01-16/HCWS201

[HCWS201]

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 13th January 2015 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Government have provided an extra £50 million of funding to ambulance services as part of our record package of support for the NHS this winter.

[Bridget Phillipson]

Notwithstanding what the Secretary of State has just said, the North East ambulance service has warned that it is under severe pressure caused by delayed ambulance turnaround times at hospitals such as Sunderland Royal. When Ministers embarked on their top-down reorganisation of the NHS, were they warned at any point that chaos would ensue in A and E departments?

[Mr Hunt]

The reforms the hon. Lady mentions mean that we have 9,000 more doctors, 3,000 more nurses and 2,000 more paramedics in the ambulance service. The point is that those reforms are putting money on to the front line, which means that the NHS is better equipped to deal with winter pressures than ever before.

[David T. C. Davies (Monmouth) (Con)]

In England around 75% of ambulances meet the target response time, as opposed to 60% in Wales. Will the Minister tell the House why ambulance response times are so much better in England than in the area of the United Kingdom run by the Labour party?

[Mr Hunt]

What is so disappointing about the health debate is that Labour Members tour TV studios trying to whip up a sense of crisis in the NHS in England, and then deny that things are even worse in Wales. Services are better in England because we have put more money on to the front line and less into management.

[Helen Jones (Warrington North) (Lab)]

Prior to Christmas, a motorcyclist in my constituency with serious leg injuries was left lying on the ground in the rain for an hour and 40 minutes waiting for an ambulance. Local people had to bring out blankets and hot water bottles to try to keep him warm, but because no ambulance arrived, the police had to commandeer a council minibus to take him to hospital. Is the Secretary of State ashamed to stand at the Dispatch Box and tell the House that the NHS is not in crisis, when that is what is happening on the ground?

[Mr Hunt]

Let me tell the hon. Lady what we are doing—[Interruption.] This is what I think is so shocking: Labour Members are not actually interested in what is happening to avoid precisely the kind of things that the hon. Lady mentioned. We are putting £4.6 million of extra support into the North West ambulance service this winter, and that money is being used to employ more paramedics, to train people so that they can see and treat patients on the spot, and to help more people on the phone so that they do not need an ambulance. The hon. Lady should perhaps have listened to the earlier question, because where Labour is running the ambulance services, results are even worse.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Does the Secretary of State agree that the rules for commissioning ambulance services need to be looked at again to ensure that ambulances serving rural areas such as South Lakeland which do not have an acute centre of their own and therefore export their ambulances further afield need to be compensated with additional ambulances to take account of the fact that so many of our vehicles are out of county most of the time?

[Mr Hunt]

My hon. Friend makes an important point about the way targets are set up. It is possible for ambulance services to hit their targets while not delivering a satisfactory service to the most rural areas, and we have discussed that issue a number of times. Because we are in the middle of a challenging winter, we do not think that now is the right time to review the issue, but he should rest assured that we are keeping it under review.

[Andy Burnham (Leigh) (Lab)]

Although focus has been on A and E, it is becoming clear that the knock-on crisis in the ambulance service is more serious than people realise. Evidence is emerging of services unilaterally abandoning national standards and putting patients at risk. We know of one ambulance service that left patients at the door of A and E without handing them over to A and E staff, and last night East of England ambulance service was forced to release an internal report on the downgrading of thousands of 999 calls, including calls made by terminally ill patients. The report covered only a sample, but it showed that at least 57 of those patients died after a decision was taken not to send an ambulance. Withholding ambulances from terminally ill people is the most cruel form of rationing imaginable. Will the Secretary of State today order a full, independent investigation into how that happened, and into every death or adverse incident?

[Mr Hunt]

We investigate deaths and adverse incidents carefully, and the East of England ambulance service got £3.6 million of extra support to help it this winter. Let us look at what is happening in the ambulance service. Year on year, the number of the most serious category A calls—those that need to be answered within eight minutes—has increased by 26% over one year, and the number of ambulances dispatched within eight minutes has increased by 22%. That is 1,900 extra ambulance journeys arriving within eight minutes, which is a record of an ambulance service doing well under a lot of pressure. The right hon. Gentleman should be getting behind the paramedics and ambulance services, not trying to politicise the issue.

[Andy Burnham]

I raised a very serious issue, which came to light last night, regarding 57 terminally ill patients. As that was only a sample, it is not the whole story. I am surprised that the Secretary of State did not answer the very specific question about a serious failure in the East of England ambulance service. The truth is that this is not confined to the ambulance service in the east of England. Last year, we heard of a 77-year-old great-grandfather from Bolton who waited for more than four hours on a freezing pavement and a 92-year-old grandmother who tragically died after waiting for five hours in agony on the floor of her home in Muswell Hill.

Whatever the Secretary of State says, those are not isolated cases. New figures last week showed that in November a staggering 17,000 critically ill patients who were classified as needing an urgent category A 999 response waited longer than 19 minutes for an ambulance to arrive. Will the Secretary of State agree that this chaos is now putting lives at risk and cannot carry on? Will he tell the House what precise steps the Government are taking to bring responses to 999 calls back up to acceptable standards?

[Mr Hunt]

But we are taking measures. That is why we have 2,000 more doctors and 5,000 more nurses compared with a year ago. Frankly, the last thing those doctors and nurses on the front line want is scaremongering by the right hon. Gentleman—posters saying that the NHS might cease to exist under this Government; and leaflets like the one I have here from Lancaster saying that the local hospital might close. We are backing the NHS with more doctors, more nurses, more resources and a long-term plan. Will he now back the NHS by disowning this kind of scaremongering and stop trying to weaponise the NHS?

[Bill Esterson (Sefton Central) (Lab)]

3. What the average waiting time was for a GP appointment in the most recent period for which figures are available.

--- Later in debate ---

[Henry Smith (Crawley) (Con)]

16. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future.

[The Secretary of State for Health (Mr Jeremy Hunt)]

A strong NHS needs a strong economy, and because this Government have put Britain back on the road to recovery, we are able to invest an additional £2 billion in the NHS front line next year. This is a down payment on NHS England’s “Five Year Forward View”—the NHS’s own plan to transform care in the community and reduce pressure on hospitals.

[Caroline Nokes]

Does my right hon. Friend agree that the NHS 111 service has been unfairly criticised by the Opposition, despite their key role in establishing it, and that it has provided impressive support this winter to our A and E departments by suggesting to patients convenient and effective alternatives to the emergency department?

[Mr Hunt]

My hon. Friend is absolutely right. Part of the solution to the pressure in A and E is providing good alternatives, and in the last year for which we have figures, the 111 service took 12 million calls, which is three times more than the 4 million calls that NHS Direct took in its last year of operation, and 27% of people said that had they not called 111 they would have gone to A and E. That is a huge success.

[Mr Spencer]

The Secretary of State will be aware of the additional pressure on Sherwood Forest hospitals trust as a result of the £40 million a year disastrous private finance initiative deal signed by the last Government. Will he meet me, my hon. Friend the Member for Newark (Robert Jenrick) and representatives from the hospital to discuss how we might move forward and deal with this terrible PFI deal?

[Mr Hunt]

I am aware of the problems with that deal, signed back in 2005, which is now consuming 17% of the trust’s income. It would like to spend that income on more doctors and nurses, but it cannot because of the shockingly bad deal signed. I would be happy to meet my hon. Friend to discuss what is possible in the current circumstances.

[Julian Sturdy]

There are many causes of the pressure on A and E, and in more rural areas direct access to services can be difficult and costly. As such, will the Secretary of State consider investing further money in new technologies that could drive a revolution in health care facilities, and if such opportunities present themselves, may I promote York and north Yorkshire as an ideal testing ground for these technologies, given its ageing population and rurality?

[Mr Hunt]

I remember my hon. Friend’s campaigning on superfast broadband in north Yorkshire from my last portfolio. He is absolutely right that technology has a big role to play. That is why a year and a half ago the Prime Minister announced plans to expand weekend and evening GP appointments through the use of technology, which is already helping 5.5 million people and by March will be helping 7.5 million people. We must absolutely consider this as a solution.

[Henry Smith]

In 2005 under the previous Labour Government, Crawley hospital’s A and E department was closed, but I am pleased to say that in recent years health and other emergency services have been returning to the facility. Will my right hon. Friend consider centring more emergency centres in Crawley, as the natural sub-regional population centre?

[Mr Hunt]

I congratulate my hon. Friend on his campaigning for Crawley hospital and pay tribute to staff at the hospital, which was rated “good” by the Care Quality Commission last year as part of the new inspection regime. He will welcome the fact that since 2010 the number of doctors at the hospital has increased by 97 and the number of nurses by 107. Of course, we will always consider ways to improve services for his constituents.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

22. The Home Secretary talked about the £2 billion he has put aside for the NHS, some £1.5 billion of which is for clinical commissioning groups and specialised commissioning. Why are more than 50 CCGs in the south of England to receive a 3.6% increase in funding to the detriment of the north, where my own CCG is to receive only 0.24%, which is below inflation and a pittance compared with the south?

[Mr Hunt]

These things are decided independently by NHS England, which made the decision on the basis of which CCGs were most off their target allocation and on social deprivation and the number of older people. I remind the hon. Gentleman that there are many older and vulnerable people in the south, too, and they need a fair settlement from the NHS. That is why the decision was made.

[Valerie Vaz (Walsall South) (Lab)]

The College of Emergency Medicine says that the extra money the Secretary of State has given is not reaching A and E. What steps is he taking to ensure that the money does not stay with the CCGs, but actually goes into A and E?

[Mr Hunt]

I have had a number of discussions with the College of Emergency Medicine and what it actually says is that the system is working pretty well—[Interruption.] Well, that is what the College of Emergency Medicine says. The country’s A and E doctors welcome the fact that with the winter pressures money, there are now 800 more doctors and 4,700 more nurses, but we always want to make sure that the money is getting through as quickly as possible, so if the hon. Lady has any particular examples, I would be happy to look into them.

[Dr William McCrea (South Antrim) (DUP)]

Surely the Secretary of State will accept that quicker appointments with the patient’s local GP will certainly alleviate some of the blockages in A and E.

[Mr Hunt]

I agree with that, and I hope that the hon. Gentleman will campaign to make sure that the Northern Ireland Executive put the extra money they have received as part of the Chancellor’s autumn statement into precisely that—good GP services for the people of Northern Ireland.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is increasingly recognised that the causes of the A and E crisis include the closure of walk-in centres, such as the one in Little Hulton in my constituency and this Government’s savage cuts to council budgets, leading in Salford to 1,000 fewer people getting care packages funded this year. When will the Health Secretary start to take responsibility for his own Government’s policies and do something to ensure investment in social care to ease that pressure on A and E? The better care fund is not the answer.

[Mr Hunt]

I am sorry, but this says it all about the Labour party’s campaign. It talks about savage cuts to social care and then the shadow Chancellor says he is not going to do anything to reverse them. It really has to be consistent. On the walk-in centre, Labour Members were saying earlier today that they want GPs present in every A and E department and that is exactly what has happened at Salford Royal. The walk-in centre was closed so that GP services could be moved closer to the A and E at that hospital. Perhaps the hon. Lady should talk to Sir David Dalton, her local chief executive, who will tell her why this is doing a better job for her constituents.

[Paul Burstow (Sutton and Cheam) (LD)]

The Secretary of State is absolutely right to highlight the success of the coalition in delivering a better economy, which is allowing us to invest £2 billion from April this year. Will he address the point put to him about the importance of social care, and seriously consider investing some of that £2 billion in social care, not just in our health care system.

[Mr Hunt]

May I reassure my right hon. Friend by saying that I agree with him? I want to pay tribute to him for campaigning on this issue for some time, both in office and out of office. The truth is that there is a strong link between what happens in the social care system and what happens in the NHS. This year, we are putting £1.1 billion of support from the NHS into the social care budget. Next year, that increases by another £2 billion. We need to recognise that these two systems need to be brought together as one system—and with the better care fund, that is what is happening.

[Mark Reckless (Rochester and Strood) (UKIP)]

To attract more senior doctors into emergency medicine—an extraordinarily demanding specialty where doctors work solely for the NHS—should we consider paying them more than they get under the standard consultant pay scale?

[Mr Hunt]

I think we need to look at the emergency medicine contracts. One thing said by the College of Emergency Medicine—I have a lot of sympathy with this view—is that emergency doctors want not more money, but the right to the same holidays that other doctors get. It is the time off that is important to them. They have to work 24/7 and they get extremely tired; they want some compensation for that in being able to spend extra time with their families. We are getting more people into emergency medicine, but we should look at anything we can do to make it better.

[Dr Sarah Wollaston (Totnes) (Con)]

NHS staff are working extraordinarily hard to deal with not only the extra demands, but the increased complexity of patient cases in all parts of the urgent care system. Will the Secretary of State set out what more can be done to make sure that people access the right part of the system and that all parts of the system work together?

[Mr Hunt]

As a former GP, my hon. Friend understands this issue better than most. For me, the single most important thing for patients with the most complex needs, particularly for vulnerable older people, is having a system where the buck stops with a doctor. Someone must be accountable for ensuring that such people get the right care wrapped around them. We have brought back named GPs for all over-75s this year as a first step, but there is much more to do.

[John Healey (Wentworth and Dearne) (Lab)]

The Secretary of State did not answer the question put by my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson). Surely the unprecedented problems we are now seeing in A and E and the wider NHS can be traced back directly to the risks of the huge top-down reorganisation, which were set out for Ministers in November 2010, but ignored. One of the current Ministers and his predecessor said, as reported in the House:

“We have every intention of publishing the risk register in due course, when we think the time is right.”—[Official Report, 10 May 2012; Vol. 545, c. 156.]

Four years on, will the Secretary of State now publish this risk register and let people see for themselves what warnings he was given about current problems and how far he has been hiding the truth on the NHS?

[Mr Hunt]

It was published, because it was leaked. The fact is that there is one part of the United Kingdom that carried out those reforms and has the best A and E performance in the country, and another part of the United Kingdom—Wales—that set its face against those reforms and has one of the worst A and E performances in the country.

[Robert Halfon (Harlow) (Con)]

5. What steps have been taken to help Princess Alexandra hospital in Harlow to deal with extra pressure over the winter.

--- Later in debate ---

[Charlie Elphicke (Dover) (Con)]

6. What assessment he has made of the level of improvement made by East Kent Hospitals NHS Trust since it was put into special measures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am pleased to report that East Kent Hospitals NHS Trust has started to make good progress since it was placed in special measures last August. That includes improved incident reporting rates, a revised policy enabling staff to raise concerns, and the creation of a cultural change programme.

[Charlie Elphicke]

Does not the Secretary of State’s answer highlight the fact that the best way of dealing with long-term and deep-set problems is to put patients first and ensure that there is a culture of transparency? Does that not contrast sharply with the denial and cover-ups that we have seen too often in the past?

[Mr Hunt]

Absolutely. I think that what shocks people is Labour trying to make political capital out of winter pressures in the NHS, and then sweeping the poor care that happened on its watch under the carpet. We are making great progress at East Kent Hospitals NHS Trust: there are 82 more nurses, and more than 100 more doctors. That is because we are facing up to the problems, not running away from them.

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

7. With reference to his Department’s publication “Transforming care: A national response to Winterbourne View Hospital”, published in December 2012, if he will take steps to ensure that the statutory guidance implementing the adult autism strategy uses clear language and is mandatory.

--- Later in debate ---

[Chloe Smith (Norwich North) (Con)]

9. What steps have been taken to support NHS hospitals in meeting increased demand in winter 2014-15.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Government have prepared for this winter earlier than ever before, with a record £700 million to help the NHS through winter, including £3.6 million to help my hon. Friend’s local area.

[Chloe Smith]

The Norfolk and Norwich university hospital has declared a major incident and is also being examined by Monitor for its waiting times. Its medical director stresses that services are safe, but we all know that there is a need to ensure that people can move on from hospitals into other parts of the health care system. Can my right hon. Friend reassure me that he would expect the use of the resources he has provided to be jointly planned out with social care?

[Mr Hunt]

Obviously this is very important, and that is what is happening now for the first time. We are seeing the true integration of health and social care through the better care fund and record working, and in my hon. Friend’s area, despite the pressures they have been feeling this winter, they have made some good progress. They have put an urgent care centre next to the A and E. They are seeing within four hours nearly 12,000 more people every year, and they are doing about 12,000 more operations every year as well.

[Mr Kevan Jones (North Durham) (Lab)]

In the Chancellor’s announcement last year of extra funding for the NHS, my clinical commissioning group got a 0.24% increase, whereas Windsor, Ascot and Maidenhead got 3.7%. The Secretary of State blamed the NHS for this when he responded to my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop), but is it not because this Government have taken need out of the formula—a similar thing to what they have done in local government—which means the movement of money from the north to the south?

[Mr Hunt]

No, we have not. The NHS funds were allocated on the basis of a formula and the extra money was given to the places that were most off-target on the basis of the number of older people, the level of social deprivation and a range of other important factors. All I would say to the hon. Gentleman is that we have increased the NHS budget in real terms in his area, whereas those on his own Front Bench wanted to cut it.

[Sir Gerald Howarth (Aldershot) (Con)]

May I take this opportunity to salute the efforts made by Frimley Park hospital, the first hospital in the land to have been awarded outstanding status by the Care Quality Commission? Is it not the case that it has responded well to the pressures and elicited praise from my constituents, which is down in large measure to the leadership of Sir Andrew Morris, who was rightly awarded a knighthood in the new year’s honours?

[Mr Hunt]

I think it is, and my hon. Friend is right that it is a brilliant hospital; it serves my constituents as well. One of the things it is doing is helping to turn around Heatherwood and Wexham Park hospitals trust, which was in special measures, including its A and E department, which is doing much better. Sir Andrew Morris has been running that hospital for 26 years, and that kind of stability in leadership makes a huge difference.

[Ms Margaret Ritchie (South Down) (SDLP)]

On easing winter pressures in NHS hospitals, could the Secretary of State indicate when he last met the chair of emergency medicine and what steps will be taken to ensure greater accessibility to GP practices?

[Mr Hunt]

If the hon. Lady is talking about NHS England head of emergency medicine Professor Keith Willett, I meet him pretty much every week.

[Mark Pawsey (Rugby) (Con)]

10. What steps his Department is taking to ensure support for smaller district hospitals.

--- Later in debate ---

[Heidi Alexander (Lewisham East) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Chancellor agreed in the autumn statement to support NHS England’s five-year forward view with the £1.7 billion of additional funding that the NHS requested. On top of that, the Chancellor allocated £1 billion of funding to transform primary care facilities, and I am pleased to announce today that a letter will shortly be sent to every single GP practice in the country, inviting them to bid for the first tranche of that funding with the aim of supporting more GP appointments and more proactive care for the most vulnerable.

[Heidi Alexander]

Last week, one of my constituents had a fall and fractured her pubic bone. She was taken to Queen Elizabeth hospital in Woolwich because 15 ambulances were stuck in a queue outside Lewisham. She then waited 12 hours on a trolley. If the Secretary of State had got his way and been successful in his attempt to axe services at Lewisham, exactly how much longer would he have expected my constituent to wait? Is it not true that if he had got his way the A and E in Woolwich would have been totally and utterly overwhelmed?

[Mr Hunt]

No, and I can tell the hon. Lady that her constituents would be receiving far worse care had we not tackled the long-standing issues with the South London Healthcare NHS Trust, which the last Government ducked but which we have confronted and dealt with. If she looks at the performance of A and E in her area, she will see that 48,000 more people are being seen within four hours than when Labour was in power.

[Dame Angela Watkinson (Hornchurch and Upminster) (Con)]

T2. The Secretary of State will be aware that the London borough of Havering has the highest proportion of elderly people of all the London boroughs, but he may not know that the average age of an in-patient at Queen’s hospital is 86. Will he agree to look at the balance of future funding between acute care and community health care, so that elderly people can be supported at home and beds freed up for people waiting for acute operations?

[Mr Hunt]

My hon. Friend makes an important point. It is one of the underlying causes of pressure in A and Es that for an over-75 attending an A and E in winter, there is an 80% chance that, rather than going home, they will be admitted to hospital and probably stay there a long time. That is why improving community care, as she says, is at the heart of this Government’s strategy to reduce pressure on hospitals.

[Mr Jamie Reed (Copeland) (Lab)]

If it is not too late, let me wish you, Mr Speaker, a happy new year.

The care failings uncovered by the Care Quality Commission at Hinchingbrooke hospital are appalling and unacceptable. The inspection

“found poor emotional and physical care which was not safe or caring.”

The response to call bells was so bad that some patients were told to soil themselves; drinks were left out of patients’ reach; and one member of staff was overheard telling a patient,

“don’t misbehave you know what happens when you misbehave.”

Will the Secretary of State tell us when he was first told about the problems at Hinchingbrooke? Given that the CQC inspection happened in September, why was the trust put into special measures only last Friday?

[Mr Hunt]

What I can tell the hon. Gentleman is that what happened at Hinchingbrooke completely destroys what Labour has been saying about privatisation, because it was this Government who introduced an independent inspection regime, which did not exist before, that roots out poor care without fear or favour. That is what we have done in 18 hospitals run by the NHS and it is what we are doing at Hinchingbrooke run by the private sector.

[Duncan Hames (Chippenham) (LD)]

T3. The three GP surgeries in Chippenham were turned down by the Prime Minister’s challenge fund, despite developing imaginative plans to bring together all the town’s acute GP care at a new urgent care centre at Chippenham community hospital. They received no feedback, even from NHS England. Will the Secretary of State be more flexible when receiving further proposals from the doctors, who are, after all, very busy looking after their patients?

[Mr Hunt]

I have met the doctors in Chippenham and been personally lobbied on that plan. I thought it sounded very promising, so I am happy to take it away and look at it again, and hopefully at some stage they can get some of the funding.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

T4. The Bournbrook Varsity medical centre is about to face a double-whammy financial crisis, as NHS England scraps its minimum practice income guarantee and forces it to switch from a personal medical services contract to a general medical services contract. Why should that excellent practice, which has done all that could be asked of it, and its patients be victimised because a high proportion of the patients are young students? Will the Secretary of State agree to look at this disaster immediately?

[Mr Hunt]

I am very happy to look at that issue.

[Jeremy Lefroy (Stafford) (Con)]

T5. The recent extraordinary pressures on A and E in the north midlands underlined for me and my constituents the importance of returning the A and E at Stafford County hospital from 14 to 24-hour opening. Given that consultant-led maternity is due to transfer from Stafford to Stoke this week and the remaining serious emergency surgery next month, will my right hon. Friend set out what steps have been taken to ensure that the safety of my constituents and other users of the services is the top priority, and advise me whether he is confident in them?

--- Later in debate ---

[Angela Smith (Penistone and Stocksbridge) (Lab)]

T8. My constituent Mr Offord waited 22 minutes after a 999 call for a double-crewed ambulance, and his death was referred by the South Yorkshire coroner to Ministers because of a concern that he might have survived if he had received medical help sooner. The Yorkshire ambulance service has just settled the case brought by Mr Offord’s family out of court. When will the Secretary of State recognise the growing crisis in ambulance services and support my right hon. Friend the shadow Secretary of State’s call for an investigation?

[Mr Hunt]

I do recognise the pressures on the ambulance service and the hon. Lady’s local area has had £1.6 million extra to help to deal with winter pressures. We have 1,700 more paramedics in the ambulance service and they are doing 2,000 more emergency journeys every day, but none of that is any consolation to the family whom she talks about, and that is why we must always ensure that every lesson is learned.

[Andrew Percy (Brigg and Goole) (Con)]

The Secretary of State, the Department of Health and my local hospital trust inform me that there are more doctors and nurses in the local NHS and the NHS nationally than there were in 2010. This weekend, residents in north Lincolnshire received a leaflet from the Labour party saying that there were fewer doctors and nurses and less care. Who is telling the truth?

[Mr Hunt]

It is not the Labour party, because all it wants to do is to turn the NHS into a political weapon. It might just think about the impact on NHS patients and staff when it does this. It does not help anyone and it is bad for the NHS.

[Kevin Barron (Rother Valley) (Lab)]

T9. Does the Under-Secretary of State remember the case that I raised in an Adjournment debate of Mrs Monica Barnes and the inadequate service she received from the health service ombudsman’s office? The ombudsman’s office has today announced a consultation on a new service charter. Does he welcome it and hope for a better service for our constituents?

[Mr Hunt]

There have been a number of problems with the service offered by the ombudsman. There has been a lack of expertise in the ombudsman’s office to investigate the most difficult cases. This is obviously a responsibility of Parliament not of mine, but I have had good discussions with my hon. Friend the Member for Harwich and North Essex (Mr Jenkin), who chairs the Public Administration Committee, about how the services can be improved.

[Mr Jonathan Djanogly (Huntingdon) (Con)]

The last week has been an extremely testing time for Hinchingbrooke hospital in my constituency, for its hard-working staff and for its loyal patients. Will my right hon. Friend please take this opportunity to confirm his Department’s full support for Hinchingbrooke hospital and to give some advice on the way management will be transitioned so as to minimise patient disruption?

[Mr Hunt]

I am happy to do that, and I reassure my hon. Friend that our top priority will be to ensure that there is a smooth transition to the new management of the hospital as Circle moves away. I thank him for the measured tone he has taken and I reassure him that his constituents’ safety and care is our top priority.

[Kerry McCarthy (Bristol East) (Lab)]

T10. At Southmead hospital in Bristol, just 81% of patients are seen within four hours and the number of blocked beds is three times the national average. At Bristol Royal infirmary it is double the national average. What is the Secretary of State doing specifically to help hospitals in the Bristol area?

[Mr Hunt]

We have allocated £8.84 million to South Gloucestershire’s strategic resilience group, and that is employing more doctors, nurses and hospital and community staff, and providing more than 100 beds.

[Greg Mulholland (Leeds North West) (LD)]

All the talk about appointments concentrates on GPs and A and E, but does not seem to focus on pharmacies, which have a hugely important role to play, considering how many years pharmacists train for. My constituent Mr. Dhand of the Headingley pharmacy is undertaking a pilot to see how many people could and should have gone to a pharmacy rather than to a GP. Would Ministers support that?

[Mr David Anderson (Blaydon) (Lab)]

Despite all the warm words we hear every week from the Government about their support for the staff of the NHS, which I welcome, the Government still refuse to pay the award recommended by the independent review body. At the same time the chief executive of the trust in my part of the world has had a 78% salary increase and the people who set the allowances, the board of governors, have had an 88% increase in their allowances. Is this what is meant by “we are all in this together”?

[Mr Hunt]

I believe that NHS managers have a responsibility to be sensible about their own pay. This is not decided centrally, but when we are asking NHS staff to make sacrifices in their own pay to make sure that we can recruit enough staff, NHS managers should set an example.

[Michael Fabricant (Lichfield) (Con)]

The Institute of Translational Medicine at Birmingham university medical school is probably the top place in Europe for genetic research into innovative cancer cures. I have visited it. Will the Secretary of State visit it, and will he ensure that funding continues for that department?

[Mr Iain Wright (Hartlepool) (Lab)]

The Secretary of State refuses to meet Hartlepool borough council and me on the issue of hospital services in Hartlepool. On Wednesday in this House he said:

“I take responsibility for everything that happens in the NHS.”—[Official Report, 7 January 2015; Vol. 590, c. 277.]

If so, will he respond to the 12,000 people who signed the petition organised by the Hartlepool Mail, the 1,000 people who marched on Saturday morning, Hartlepool borough council and me on this issue? Will he stop snubbing the people of Hartlepool, work with us and make sure that hospital services can return to Hartlepool?

[Mr Hunt]

I do take responsibility, but I hope the hon. Gentleman will be responsible in his campaigning in Hartlepool and welcome the extra doctors, extra nurses, extra operations and extra number of people seen within four hours in his constituency. It is a record of success, of which this Government are proud.

[Steve Baker (Wycombe) (Con)]

As it becomes increasingly obvious that the public insist on receiving urgent care in a hospital setting, will the Government move to incentivise the delivery of a new generation of urgent care centre, as specified in the end of the phase 1 report on the urgent and emergency care review?

[Mr Hunt]

I have visited my hon. Friend’s local hospital. I commend him for his interest and I commend the hospital for the remarkable turnaround. From being a hospital in special measures, it has done extremely well. We want to implement the proposals in that review and we want also to make sure that for the oldest and frailest people there are alternatives that mean that they do not have to visit hospital.

[Several hon. Members]

rose—

Cancer Drugs Fund

Jeremy Hunt Excerpts

Monday 12th January 2015 Ministerial Corrections

[David T. C. Davies (Monmouth) (Con)]

6. How many patients have received treatment through the cancer drugs fund since the inception of that fund.

[The Secretary of State for Health (Mr Jeremy Hunt)]

More than 60,000 patients in England have received treatment through the cancer drugs fund since its inception in October 2010. They and their relatives will be very concerned at the suggestion made by the shadow Health Secretary last month that a Labour Government could abolish the fund.

[David T. C. Davies]

I congratulate the Secretary of State on that very high figure. Is he aware that some of those people who are being treated have had to sell up their homes and move here from Wales, where they are routinely denied life-prolonging cancer drugs by the Labour-run Welsh Assembly Administration. What does that teach us about the respective differences between the health services in England and Wales?

[Mr Hunt]

I thank my hon. Friend for raising that point. The last Labour Government did leave us with one of the lowest cancer survival rates in western Europe, which is one of the reasons why we introduced the CDF. Unfortunately, the current Labour Government in Wales are continuing with those policies, which is why 6,500 Welsh cancer patients were admitted for treatment in English hospitals last year.

[Official Report, 25 November 2014, Vol. 588, c. 732.]

Letter of correction from Mr Hunt:

An error has been identified in the response I gave to my hon. Friend the Member for Monmouth (David T. C. Davies) during Questions to the Secretary of State for Health.

The correct response should have been:

[Mr Hunt]

I thank my hon. Friend for raising that point. The last Labour Government did leave us with one of the lowest cancer survival rates in western Europe, which is one of the reasons why we introduced the CDF. Unfortunately, the current Labour Government in Wales are continuing with those policies, which is why last year there were 6,500 admissions to English hospitals for cancer treatment where the patient was from Wales.

A and E (Major Incidents)

Jeremy Hunt Excerpts

Wednesday 7th January 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the major incidents that have been declared at a number of hospitals and on A and E performance in England.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Mr Speaker, I welcome this opportunity to come to the House and make a statement on accident and emergency services.

First, we must recognise the context. The NHS always faces significant pressures during the winter months, but, with an ageing population, we now have 350,000 more over-75s than just four years ago. As a result, we are seeing more people turning up at our A and Es, with 279,000 more attendances in quarter three of this year as compared with last, and a greater level of sickness among those who do arrive, leading to an increase in emergency admissions of nearly 6% on last year. This picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland all missing key performance standards as a result.

A number of hospitals have declared major incidents over the past few days, in what is traditionally a particularly busy time in A and E. A major incident is part of the established escalation process for the NHS, and has been since 2005. This enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.

The decision to declare a major incident is taken locally—there is no national definition—and we must trust the managers and clinicians in our local NHS to make these decisions, and support them in doing so by making sure there is sufficient financial support available to help deal with additional pressures.

I chaired my first meeting to discuss that support on 17 March last year. On 13 June, we gave the NHS an additional £400 million for winter pressures, topped up in the autumn by £300 million to a record total of £700 million, ensuring local services had the certainty of additional money and time to plan how best to use it.

The NHS started this winter with 1,900 more doctors and 4,800 more hospital nurses than a year ago. This planning and funding has been widely welcomed by experts in the system, including NHS England, NHS Providers, the College of Emergency Medicine and the NHS Confederation. The funding the Government have put in, which is on top of the year-on-year real-terms increases in funding, is made possible by a strong economy, and will pay for the equivalent of 1,000 more doctors, 2,000 more nurses and 2,000 other NHS and care staff including physiotherapists and social workers. It will fund up to 2,500 additional beds, both in the acute and community sectors, and also provide £50 million to support ambulance services.

But the NHS also needs longer-term solutions to these pressures. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, with over 4 million already benefiting. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. And we have funded the NHS’s own plan to deal with these pressures, the five-year forward view, with an additional £1.7 billion for the NHS in 2015-16 and £1 billion of capital over the next four years to improve primary care facilities.

Mr Speaker, let me finish by thanking hard-working NHS staff across the country for the outstanding care they continue to deliver under a great deal of operational pressure.

[Andy Burnham]

All over England, the NHS is stretched to the limit—and in places is at breaking point. Staff are working flat-out and we thank each and every one of them for all they are doing, but the situation is now serious and getting worse. Right now, too many vulnerable people are exposed to too much risk, waiting hours for ambulances to arrive, and held in the back of them outside A and E or on trolleys in corridors. This cannot be allowed to carry on. Patients and staff deserve better answers than they have had to date about what is being done to address this issue, and that is why, faced with this complacency, we have again had to force the Secretary of State to come here today.

Fourteen hospitals have declared major incidents. Will the right hon. Gentleman explain clearly what this means for services in those areas? What is the official advice to people living in those areas? Is he providing any central support and advice to those hospitals? If a number of major incidents are declared in the same area at the same time, what contingency plans will be put into place to protect the public? More broadly, what new measures does he have under active consideration to ease pressure at all hospitals?

The Secretary of State mentioned resources. When he allocated additional resources for winter pressure, what assessment was used to determine how much was needed? Clearly, it is not working. Does he now plan to reassess the situation and perhaps allocate more? Ministers keep blaming unprecedented demand, but the question is this: why is there such unprecedented demand? Could it have anything to do with the difficulty in getting a GP appointment, the closure of walk-in centres or the cuts to social care?

Let me turn to ambulance services. There are alarming reports of people waiting hours for ambulances to arrive. This is because ambulances are trapped in queues outside A and E departments. We are hearing that at least one service has implemented a policy of leaving patients at the door of A and E without handing them over to A and E staff. Is the Secretary of State aware of this practice, and is he satisfied that it is not putting patient safety and care at risk?

The last time we had to drag the Secretary of State here, he failed to inform the House that he had approved a proposal to relax 999 response times. So will he today tell the House what the current status of those plans is and whether they are still going ahead this winter? I have real concerns, which I have relayed to ambulance leaders, about making any such change without proper consultation and evidence. There are also reports of police and fire vehicles being used to carry people to A and E. What discussions has he had with police and fire service leaders about this practice? What training or advice has been given to front-line police and fire staff? Is he fully satisfied that patient safety is not being compromised?

Finally, cuts to social care are a root cause of the pressure on hospitals. A record number of elderly people are trapped in hospital beds, and any solution to this crisis must involve councils and a solution for social care. So will the Secretary of State now act on our constructive proposal to hold an urgent summit of all the public services affected—councils, police and fire services—and to develop a co-ordinated plan to ease this crisis? NHS staff deserve it. Safe patient care demands it. When will he deliver it?

[Mr Hunt]

First, let me thank the right hon. Gentleman for this opportunity once again to go through the plans that we have in place to support the NHS and to reiterate the gratitude of the whole House to NHS staff for what they are doing under huge pressure at the moment. Let me start by telling him where I agree with him. I agree that what happens in the social care system is closely linked to what happens in the NHS. That is why, from June last year, meetings have been happening in 140 local authority areas between the local NHS and local authorities to work out how best to plan for winter. The result of that planning process, which is funded by £700 million of Government support, is extra doctors, extra nurses, extra beds and new plans in every area. I am absolutely satisfied that that money is making a difference. Every day in our A and E departments, 2,500 more people are being seen within four hours than was the case four years ago when the right hon. Gentleman was Health Secretary. The local structures worked last year, and they are working now. Now is the time to get behind them and to support the local NHS.

In a letter that the right hon. Gentleman wrote to me yesterday, he talked about Government failure. This is not the time to play politics—[Interruption.] Perhaps Opposition Members will listen to this. The head of NHS England, Simon Stevens, a former Labour special adviser, said yesterday

“the NHS, the Department of Health and local clinicians have done everything that could reasonably be expected”

to put in place plans over the last weeks. If the right hon. Gentleman will not listen to that, perhaps he will listen to Rob Webster, who runs the NHS Confederation, a representative body of all NHS organisations. He says that we should be grateful for the huge effort NHS staff have put in over the past few weeks and that it is not the time to play political football.

The right hon. Gentleman talked about ambulances, where we are putting in £50 million of support this winter, and some changes proposed by the Association of Ambulance Chief Executives, which he was informed about three months earlier than they came to public light. This is what the AACE said:

“We have been surprised by some of the reaction today given that over the last three months the principles of what we are proposing…have been shared with Labour…and we have received no negative feedback”.

What did the right hon. Gentleman say? He said it was a panic decision to relax 999 standards. There was no panic, no decision, no relaxation of 999 standards; I did what any Health Secretary should do: I simply asked for clinical advice on what would be best for patients. He chose to frighten the public, to scaremonger for party political purpose. Is it not time the Labour party, for once, thought about the impact on patients of the kind of things it is saying in the press?

The right hon. Gentleman then talked, and the Leader of the Opposition has talked, about the causes of these challenges being the reforms this Government introduced in this Parliament. Let me say to him that the one part of the UK that introduced these reforms, England, happens to have the best A and E performance and the one part of the UK that has most set its face against these forms, Labour-run Wales, has one of the worst performances. If he wants to do something about A and E pressures, instead of trying to make political capital in England, he should be getting Labour to turn things round in the one place it does run the health service—Wales. He should be backing this Government’s support for the NHS in a difficult period that has meant more doctors, more nurses, more people being seen quickly, more operations, long-term support and a plan for our NHS; it should not be politics and scaremongering ahead of an election.

[Dr Sarah Wollaston (Totnes) (Con)]

May I join the Secretary of State in warmly thanking NHS staff, who are stepping up to meet the extraordinary increase in demand for their care and expertise? Will he reassure the House that in meeting this extraordinary, complex challenge, they will not be made to chase targets, as we know that that was distorting clinical priorities in Mid Staffs, and that clinical staff should always feel absolutely confident that they have his support to place clinical priorities first and foremost?

[Mr Hunt]

My hon. Friend is absolutely right about that, and it is very important. Targets matter, but not targets at any cost. It is worth remembering that, over the four years we were seeing the tragedy unfold in Mid Staffs, it was meeting its A and E target the majority of the time. So it is very important that patient safety is the priority. That is why we have to support NHS trusts when they have major incidents and why we have to make it clear that, although targets matter, trusts need to be sensible and proportionate in their efforts to meet those standards.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Does the Secretary of State accept the truth of the assertions by A and E doctors and nurses that the call handlers working for the 111 service are referring far more patients to A and E than happened when NHS Direct was staffed by nurses, who exercised professional discretion?

[Mr Hunt]

It is always important to keep the algorithms used by call handlers—111—under review. I say to the right hon. Gentleman that 111 is part of the way we have been able to relieve pressure on A and E departments. Calls to 111 doubled this Christmas, and 27% of the people who called it said that they had been planning to go to an A and E department but did not do so following the call. That is a very important way of relieving pressure on our A and E departments.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

Does the Secretary of State share my recollection that five years ago no political pundit of any kind predicted that the welcome ageing of the population and the ending of the 24 hours a day, seven days a week commitment of general practice would produce the quite extraordinary surge in demand that we now have to cope with? Does he therefore agree that instead of wild criticisms of local crises he needs to persist in the short term by providing resources and improving co-operation between social services and health care, and in the long term by implementing the changes necessary in response to demand, as set out by Simon Stevens in his report, which our reforms have enabled NHS England to produce?

[Mr Hunt]

My right hon. and learned Friend speaks with a great deal of wisdom as someone who has occupied this post and he is absolutely right. All Health Secretaries face pressures of the kind we are going through now and face difficult winters. Winter is always a difficult time for the NHS and, as the Prime Minister said, we need a short-term plan to help—that is what our plan of creating about 5,000 extra front-line clinicians this winter alone is doing—but we must also consider the long-term plan. That involves finding a better way of looking after vulnerable older people other than through A and E departments—that means better care in the community, better support from GPs and better community services—and that is exactly what we are doing.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Bolton Royal hospital is one of the hospitals declaring a major incident. The context is as follows. The Little Hulton walk-in centre was closed, when it saw 2,000 patients a month. Salford city council had £100 million cut out of its budget, so 1,000 people this year are losing care packages. I have an elderly constituent who was admitted to Bolton Royal following poor care. It is obvious that those things are causing the problem. When will the Secretary of State take responsibility?

[Mr Hunt]

We take responsibility and I take responsibility for everything that happens in the NHS. Let me tell the hon. Lady what we are actually doing, because there have been some serious bed capacity issues in Bolton. Bolton has had £3 million this winter to help deal with those pressures, which has included £340,000 to spend on additional beds in the hospital supporting the A and E department and more than £100,000 to pay for additional staff in A and E. Overall, compared with in 2010, there are 114 extra doctors and 571 extra nurses. She should welcome that, rather than trying to make a political issue of it.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

May I remind the House that the private finance initiative, which expanded hospitals to 100 from zero after 1997, created at least £2 billion to £10 billion, and possibly even £20 billion, of additional costs that could now be used? In Hereford, the hospital is too small because of PFI. I have estimated that £30 million could have been spent on the hospital if contracts had been properly implemented in the first place. That is why my hospital, which declared an incident this week, has been struggling and it is quite wrong to suggest otherwise.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is absolutely right. I congratulate the doctors and nurses who are working very hard in his local hospital and point out that there are a number of historical problems. The £71 billion of PFI debt is one of those and it means that more than £1 billion every year is diverted from the front line. We have done something about the top-heavy management structures and, as a result, across the NHS we have 9,000 more doctors and 3,000 more nurses. It is very important in this debate that we focus not only on short-term pressures but on dealing with the long-term issues in the NHS. That is what we want to do in his area and in every area.

[Kevin Barron (Rother Valley) (Lab)]

On 9 December, a member of my family was admitted to Rotherham hospital through A and E after a fall at home. She was told two days later by a doctor that there was no medical reason she should be in hospital. She spent her 93rd birthday, on 24 December, in Rotherham hospital and was discharged on Monday of this week, having at last got a care package together. Does the Secretary of State think that the cuts to Rotherham borough council’s social services have helped or hindered the situation?

[Mr Hunt]

We need to have much better working between the health and social care systems. If the right hon. Gentleman supports that, he should support the better care programme, which from April of this year will see co-operation between the local NHS and local authorities in 150 local authority areas for the first time. Instead, Labour is calling for that plan to be halted.

[Robert Halfon (Harlow) (Con)]

Will my right hon. Friend thank the staff of the NHS at Harlow Princess Alexandra hospital for their passion and commitment? Although the Government have invested £5 million in our accident and emergency services, issues in nearby hospitals mean that the pressure on our A and E has been immense. Princess Alexandra hospital is one of the busiest by far for attends by bed and one in five ambulances arrives from out of the area. The PAH is now admitting four more patients a day than it was this time last year. Will my right hon. Friend meet me and the chief executive of the Princess Alexandra hospital, and will either he or the Minister responsible for hospitals visit the hospital to see what can be done to help the situation?

[Mr Hunt]

I am very happy to do that and I am aware of the significant pressures at the Princess Alexandra. I thank my hon. Friend for the way in which he is supporting staff in his local hospital, getting behind local plans. It is a mistake to say that there is always a new national initiative. Lots of people in the NHS have been saying over the past few days that they do not want new national initiatives. They want exactly what my hon. Friend is doing; they want people to support their local NHS and not to turn it into a political football.

[Hazel Blears (Salford and Eccles) (Lab)]

On Monday evening, the trust of Salford Royal hospital, which, as the Secretary of State knows, is an excellent hospital, declared a major incident. I am pleased to say that the pressure has been dealt with and it has now been lifted, but it is clear to me that many of the thousands of elderly and frail people in hospital have dementia, which means that they stay longer and are readmitted more often. I welcome the better care fund, but it will not be enough. There needs to be a whole systems change to prevent people from being admitted in the first place, with better support and more action by GPs. We need to get on with that urgently.

[Mr Hunt]

I agree entirely with the right hon. Lady. The better care fund is a first step, but it is only a first step. It is happening from this April, but we have the NHS England five-year forward view, which is the long-term plan to improve community care. I agree that Salford Royal is an excellent hospital. It had £3.5 million to help it deal with winter pressures this year, but it is also a good example of how integrated care between the acute trust and local community services can make a real difference, and it is delivering some of the safest care in the country.

[Paul Burstow (Sutton and Cheam) (LD)]

May I pay tribute to the accident and emergency staff at my local hospital, St Helier, whom I met on Monday? One thing they made clear to me is that although there is no single cause of the pressures on A and E at the moment and there is therefore no single solution, they want certainty about the long-term plans for NHS funding. Although the down payment of £2 billion announced in the autumn statement was very welcome, will the Secretary of State say whether the Government or any Government in whom he might participate in the future will deliver the additional £8 billion necessary to secure the closing of the funding gap that Simon Stevens identified?

[Mr Hunt]

When we did the autumn statement last year, we asked Simon Stevens and NHS England how much they needed for their plan next year and they told us it was about £2 billion, so we made that commitment. We also said that that was a down payment on delivering the entire plan, not a one-off payment. I agree about the importance of long-term certainty over funding, but the most important thing in that regard is to have a strong economy that can deliver the money that will support our NHS. It is only Government Members who have shown that they are capable of delivering that strong economy rather than the instability that would come from disastrous economic policies.

[Grahame M. Morris (Easington) (Lab)]

The Secretary of State and Prime Minister accuse the Labour party of using the NHS as a political football and as a weapon. May I advise the Secretary of State that the NHS is a weapon—a very powerful one—for the treatment of illness and the relief of disease and suffering, and that it is being blunted by this Government and his Department under his stewardship? I met the chief executive of City Hospitals Sunderland NHS Foundation Trust about the NHS crisis and the A and E crisis, and one of the problems he identified was the lack of sufficient staff and the need to recruit locums. What is the Secretary of State doing about recruiting more staff and how many vacancies are being carried?

[Mr Hunt]

I agree that we need more staff, but the hon. Gentleman should welcome the fact that under this Government there are 9,000 more doctors and 3,000 more nurses. Such an increase was made possible by a reorganisation that took money away from bureaucracy and management and put it on to the front line. What is wrong is for the Leader of the Opposition to say that he wants to weaponise the NHS—turn it into a political weapon. The NHS is not a political weapon; it is there for patients. Labour should be ashamed of trying to turn it into a political football.

[Sir Alan Haselhurst (Saffron Walden) (Con)]

Is my right hon. Friend aware that the declaration of a major incident by Addenbrooke’s hospital has caused concern among my constituents whose non-urgent admissions have had to be postponed? Is he also aware that the hospital is currently looking after more than 300 people aged over 85, which is in itself a remarkable tribute to the NHS? However, such a figure underlines the fact that we have to give more attention to the integration of health and care issues.

[Mr Hunt]

I am aware of the problems at Addenbrooke’s. Indeed, the main issue, as my hon. Friend rightly says, is delayed discharges relating to care. The chief executive is running the command and control system and working with the local authority to facilitate the discharges that are necessary and to de-escalate the situation. The hospital has £2.2 million for its winter pressures support and 185 more doctors than four years ago.

[Derek Twigg (Halton) (Lab)]

The national health service in my constituency is under immense pressure, as are the adult services. It has been known for some months now that the number of acutely ill people coming into hospital has been growing. Has the Secretary of State investigated the reasons for that significant increase, which I am hearing about from the chief executives of the hospitals? If he has, what are those reasons? Is it to do with access to primary care, or problems with adult social services? Will he tell the House now?

[Mr Hunt]

We have looked into that matter in huge detail. There are probably three broad factors that are behind the increase in demand. One is the ageing population. There are 350,000 more people over the age of 75 than four years ago. The point is that if someone of that age goes into A and E in the winter, there is an 80% chance they will be admitted to hospital and quite a large chance they will stay in hospital for some time. The second factor is changing consumer expectation among younger people who want faster health care—[Interruption.] That is what Professor Keith Willett, the director of emergency care at NHS England, said, and Opposition Members should listen to what our clinical leaders are saying. The third factor is a refusal by NHS trusts to do what they were pressurised to do in the past, which is to cut corners to hit targets.

[Angie Bray (Ealing Central and Acton) (Con)]

My right hon. Friend will be aware that there have been significant changes to hospital services across north-west London. There is considerable concern from some of my constituents that the closure of A and E departments at Central Middlesex and Hammersmith hospitals has led to some of the increasing pressure elsewhere. Will he tell me whether there is any evidence of that?

--- Later in debate ---

[Mr Hunt]

I am aware that there have been particular pressures at Northwick Park hospital, but I am also aware that a plan is in place in north-west London to have weekend opening of GP surgeries to improve out-of-hospital provision. The pressures that are faced there are like those in the rest of the country—very severe. We are doing everything we can to support the hospitals in that area with our winter pressures plans.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Secretary of State spoke about the algorithms used by 111 call handlers. Does he appreciate that a frightened mother with a sick child is not really interested in algorithms? What she wants to know is that her child can get the medical help that they need promptly. He has told the House that he has been having meetings on this winter crisis since March. Is he not a little bit embarrassed that we now have people queuing to see their GPs first thing in the morning, ambulances queuing outside hospitals, people being treated in tents outside hospitals, and old people staying in hospital longer than they need to because there is a lack of funding and no proper co-ordination between health and social care?

[Mr Hunt]

Of course I regret any individual incidents where people do not get the care they need promptly. The hon. Lady will know that the solutions to such problems are not always things that can be done overnight. If she looks at the record of joined-up care over the past few years, she will see that this is the first Government to encourage 150 local authority areas to sit down with their local NHS and jointly plan care for the most vulnerable people in the social care system. That is a very big step forward. We are also doing nearly 1 million more operations every year across the NHS. In accident and emergency, the number of people being seen within four hours has gone up by nearly three quarters of a million since the start of this Parliament. That is real progress, but of course there are long-term issues, and we will focus on those as well.

[Andrew Percy (Brigg and Goole) (Con)]

I congratulate Goole hospital on hitting its target 99.7% of time, and the trust as a whole on hitting its target 93% of the time. I spent my Christmas volunteering in the NHS at A and E and with the ambulance service. Staff repeatedly told me that as first responders what they see are more old and frail people needing to be admitted to hospital. That situation was not helped by 50,000 hospital beds being cut by the previous Government. One way of dealing with the problems would be to move to a community paramedicine model and to use the skills of our ambulance services more. I encourage the Secretary of State to ensure that NHS England is seriously looking at that option.

[Mr Hunt]

May I congratulate my hon. Friend on the shining example he gives to everyone in this House by being a first responder? I do agree that one thing that we could do in the next year is to integrate better what happens in the ambulance services, out-of-hours GP services and 111. Individually, they are all doing a good job, but they could do a much better job if what they did was integrated.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Facts are important in this debate. There is now good evidence to show that overcrowding in emergency departments increases mortality and length of stay. Will the Secretary of State ensure that the figures for hospitals are available in the House of Commons on a monthly basis, so that we can correlate spikes following emergencies with what happens to mortality rates? If mortalities increase, the problem is even more serious than we think it is.

[Mr Hunt]

I agree with the hon. Lady. It is critical that we look at the data carefully. I will see whether the data on mortality rates are available on a monthly basis. I will be as interested as she is to see it.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I have just been visiting a much-loved elderly relative in hospital and I have seen what a wonderful job our nurses are doing and the pressure that they are under, but may I tell the Secretary of State that Huddersfield and Calderdale used to have an amazingly good partnership of people in the health service working together. The antagonism now between trusts and commissioning services has destroyed that partnership. All we have now is tension and stress. We no longer have a partnership delivering health care in our country.

[Mr Hunt]

I agree with the hon. Gentleman about the hard work of the doctors and nurses at his local trust, but the feedback I get from the front line is of closer partnership working than has ever happened before, with the local authorities and the local NHS sitting down together planning what they will do for the most vulnerable older people through the better care fund. I want to encourage that everywhere I can.

[Sir Richard Ottaway (Croydon South) (Con)]

I join the Secretary of State in praising Croydon University hospital staff who have been working their socks off in recent days, but is he aware that CUH has a recently modernised subsidiary in Purley with a minor injuries unit, which is open only in the afternoons, and an under-used X-ray department? Will he explore with Croydon commissioning group whether those facilities can be used full time, because that would take the load off the A and E department at Croydon University hospital?

[Mr Hunt]

I am happy to explore that. All these suggestions need to be considered very carefully. That trust has had 40 extra doctors and nearly 300 extra nurses and £4.5 million to help with its winter pressures this year. Perhaps some of that money could be used for that purpose. I am happy to look into it.

[Mr David Lammy (Tottenham) (Lab)]

As the Minister who introduced the precursor A and E target, may I say that the Secretary of State was right to continue with the target? Making the target work was dependent on NHS Direct, delayed discharges, the integration of social care, and targets in the rest of the hospital, particularly on cancer. He has demolished that whole system. Will he now apologise for the absence of those targets, the problems in delayed discharge and the scrapping of NHS Direct?

[Mr Hunt]

I am afraid that what the right hon. Gentleman says is simply not correct. We have continued with key operational targets. A number of them are under pressure, but when we look at each of them we see that the reason is that the NHS is treating more people than ever before but demand is outstripping supply. For example, nearly half a million more people visited A and E in the most recent quarter than in the last quarter of the previous Labour Government, and we have 1,000 more doctors in our A and E departments. That tells us that, along with short-term help with these pressures we need a long-term solution, which is what this Government are committed to.

[Andrew George (St Ives) (LD)]

This is a serious and complex issue, and one of the factors causing it is that many seriously ill patients cannot be admitted to acute hospital wards because there are insufficient beds. In the light of that, I draw the Secretary of State’s attention to an NHS Confederation report from May 2006, “Why we need fewer hospital beds”. I cautioned at the time that it would be unwise to pursue such a policy without first front-loading primary and social care. Will he look at enhancing acute hospital beds until primary and social care have the capacity to help out the acute sector?

[Mr Hunt]

The hon. Gentleman makes an important point. In fact, I was talking with someone senior at the Royal Cornwall hospital on Monday about the particular pressures there. Indeed, some of the funding that we allocated to the NHS in the autumn statement for next year is designed to do precisely that—to allow hospitals to maintain bed capacity while we ramp up facilities in community and primary care. It is very important to get the timing absolutely right.

[Lilian Greenwood (Nottingham South) (Lab)]

Yesterday the emergency department at Nottingham’s Queen’s Medical Centre faced such intense pressure that the trust was forced to enact its internal incident plan and cancel planned operations and out-patient clinics. Higher than expected admissions and delays in discharging patients who are well enough to leave hospital have been creating problems for many months. How can we resolve what is now a crisis if the Secretary of State will not even acknowledge that his Government’s deep cuts to social care are undermining the efforts of our dedicated NHS and social care staff?

[Mr Hunt]

We are doing an enormous amount to support social care. Some £3.9 billion of NHS funds has been given to the social care system over this Parliament, and we have strongly encouraged local authorities to ensure that any savings they have to make are done through efficiency savings, not cuts to front-line services. The hon. Lady’s local hospital has received £11 million in funding to help it through the winter. We are doing a huge amount to support the NHS through a difficult period, and she should support those efforts.

[Sir Tony Baldry (Banbury) (Con)]

It is obviously important that those who need to be treated in A and E are treated there and that those who do not go to those parts of the NHS where they can be treated best. Does my right hon. Friend agree, therefore, that the initiatives taken by clinical commissioners in Oxfordshire where, for example, they are trying to triage patients essentially at the door of A and E so that those who need to go in can do so and those who need primary care get it, will help reduce pressures on A and E and ensure that people are treated in the right part of the NHS?

[Mr Hunt]

Those are exactly the kinds of initiatives that can make a big difference—indeed, they are recommended by the College of Emergency Medicine. Of course, the long-term solution is to ensure that people are better looked after at home so that they do not need to end up at the door of a hospital. That is why more proactive care by GPs—we plan to recruit 5,000 more GPs over the next five years—should mean that that becomes less of a pressure point.

[Yasmin Qureshi (Bolton South East) (Lab)]

The Royal Bolton hospital in my constituency yesterday declared a major incident. As of 1 pm yesterday, there were 53 people in the A and E department, 15 waiting for a bed, some for more than 12 hours, and a number of non-urgent operations were cancelled. I thank the hospital for all its hard work, because there have been problems for the past few weeks. I would like the Secretary of State to deal with the crisis by immediately reopening walk-in centres, because their closure is the reason so many people are going to A and E, and have proper funding given to local authorities so that they can put in place a proper health and social care budget for the elderly and vulnerable.

[Mr Hunt]

There have indeed been pressures at the Royal Bolton hospital, particularly in relation to bed capacity and intensive care unit capacity. All patients on the wards have been reviewed and discharges have been created—the plan was to discharge between 30 and 50 patients before the end of yesterday. We are doing a lot to support the hospital. It has been given £3 million in winter money, £350,000 to create extra bed capacity and £100,000 for extra A and E staff.

[Several hon. Members]

rose—

[Mr Philip Hollobone (Kettering) (Con)]

Kettering general hospital is experiencing its busiest winter on record. The three hon. Members for north Northamptonshire, the hon. Member for Corby (Andy Sawford), my hon. Friend the Member for Wellingborough (Mr Bone) and myself for Kettering, are working together to attract extra investment into our A and E. When we go to see the Secretary of State’s colleague, the hospitals Minister, next week, will he encourage the Minister to receive us warmly and favourably?

[Mr Hunt]

I think that my hon. Friend should always be able to count on being received warmly and favourably. There are particular pressures in Northamptonshire. I am planning to have a conversation with the chief executive of Northamptonshire county council in the next week to see whether there is anything more that can be done to facilitate discharges and relieve the pressure at Kettering.

[Mark Reckless (Rochester and Strood) (UKIP)]

I greatly welcome the £13.4 million of investment recently signed off for Medway hospital’s A and E department. Does the Secretary of State also understand the hospital’s need for a further £20 million of capital for medical wards around the A and E department to support integrated care and improve the throughput of patients to assist in turning around Medway hospital?

[Mr Hunt]

I am aware of those proposals, which we will obviously look at carefully. I am also aware that there are big pressures in the A and E department at Medway, but there are also other, more profound issues to do with the leadership at the hospital. The hon. Gentleman should rest assured that we are taking every step possible to try to turn things around.

[Sarah Newton (Truro and Falmouth) (Con)]

I recently spent a shift at the Royal Cornwall hospital’s A and E department and saw at first hand the fantastic work it is doing. Does my right hon. Friend agree with the clinical team and with Mr Virr, who leads the department so well, that people need to remember that A and Es are for life and limb emergency treatment on the day and that they should consider the excellent alternatives, such as minor injuries departments and out-of-hours GP services, before automatically going to A and E?

[Mr Hunt]

I commend my hon. Friend for her tremendous interest in the Royal Cornwall hospital and for her campaigning to support its efforts. I spoke with the chief executive earlier this week about the particular challenges with discharging patients. I also spoke with the deputy chief executive of the South Western Ambulance Service NHS Foundation Trust about the dramatic increase in 999 calls this winter. My hon. Friend is absolutely right that the public can help us by ensuring that they use alternatives to A and E wherever possible.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

When I led an integrated health and social care team 20 years ago, we found that carers no longer being able to care was a key reason why people went into hospital and into care. Will the Secretary of State now look again at the eligibility criteria introduced under the Care Act 2014 and ensure that a much greater number of carers can get support, because at the moment the number is being reduced?

[Mr Hunt]

Under that Act we introduced national eligibility criteria to try to remove the postcode lottery that had existed previously. We have also introduced new rights for carers that require local authorities to take account of the pressures on them. I think that we are going in the right direction, but I accept that there is always more that can be done.

[David T. C. Davies (Monmouth) (Con)]

Some 92.6% of patients in England are seen within four hours, as opposed to just 83.8% of patients in Wales. If Labour wants to make this a political football, why does it not play an away game down in Cardiff, where it is in charge and responsible for the disgracefully lower standards that we receive there?

[Mr Hunt]

My hon. Friend makes his point powerfully, as ever. The rhetoric that we have heard from the Labour Benches today is interesting for its absence when we have debates on Wales. It seems to the public watching this that there is one rule for England and one rule for Wales, and that Labour is satisfied with lower standards in the parts of the country that it runs.

[Geraint Davies (Swansea West) (Lab/Co-op)]

The NHS is in financial crisis, with more money needed for A and E, yet we are spending £10 billion a year on diabetes because people are consuming twice the daily amount of sugar that they should be consuming—nine teaspoonfuls for men, which is equivalent to a can of Coke, or six for women, which is equivalent to a light yoghurt. Does the Secretary of State agree and will he support my Bill, which is published today, which requires manufacturers to express sugar content in teaspoonfuls on products to empower consumers to make rational choices in order to manage down overall obesity—

--- Later in debate ---

[Mr Speaker]

No. I am not debating with the hon. Gentleman; I am telling him. His inquiry suffered from one little disadvantage: it was too long.

[Mr Hunt]

I have spoken to the hon. Member for Swansea West (Geraint Davies) about his Bill. Part of the long-term solution is to give people better information about sugar consumption. We will certainly look at what the Bill proposes.

[Mrs Anne Main (St Albans) (Con)]

My right hon. Friend will be aware that the Minister for Policing, Criminal Justice and Victims, my right hon. Friend the Member for Hemel Hempstead (Mike Penning), and I were very unhappy that the A and E was closed and moved to Watford. Since then Watford hospital has had a turbulent time. This morning the chief executive resigned, having got part-way through a process of consultation. May I ask for the consultation to be put on hold until the new chief executive is in place and has their feet under the table? We do not need more turbulence in our hospitals in west Hertfordshire.

[Mr Hunt]

I am sorry to hear the news about the chief executive at Watford. I am aware of the pressures there and I agree with my hon. Friend about the need for stability in management as much as possible over the next few months.

[Bill Esterson (Sefton Central) (Lab)]

One of my constituents wrote to me about her elderly mother who faced a wait of many hours for an ambulance to A and E. My constituent told me that at A and E she saw patients on trolleys backed up through the corridor to ambulances waiting in the car park. Meanwhile, patients were waiting at home, unable to get those same ambulances. She described the scene as “a war zone”. Is it not the case that A and E is unable to cope, the ambulance service is unable to cope, and patients who need to go to A and E are suffering?

[Mr Hunt]

I agree that there are real pressures in A and E across the system, but it is important to remind the public that even under that pressure, nine out of 10 people continue to be seen, treated and sent home within four hours. That is an extremely impressive record for the people working very hard in our A and E departments.

[Chloe Smith (Norwich North) (Con)]

The Norfolk and Norwich hospital declared a major incident. Its medical staff say that care is safe. Will my right hon. Friend join me in supporting Norwich NHS staff and their innovative urgent care unit, will he urge Norwich GPs to apply to the access fund, and will he condemn some of Labour’s political leaflets in Norwich which carry fake NHS stories, as told to me by NHS workers?

[Mr Hunt]

It is important for all parties to behave responsibly when the NHS front line is under such pressure. My hon. Friend might want to remind her Labour opponents locally that in Norwich there are 97 more doctors than four years ago and 145 more nurses, all possible because of a strong economy.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

Last week 1,631 people visited Plymouth A and E. One in 10 of them waited more than four hours. Staff are showing great dedication and doing extra shifts, but that is not sustainable. Will the Secretary of State please take his head out of the sand and, if he is serious about depoliticising the issue, will he take up the shadow Secretary of State’s offer of a cross-party summit to look at all the issues behind the crisis?

[Mr Hunt]

I was talking to a doctor at Plymouth last night and I recognise that there are real pressures there and staff are working very hard. The long-term solution is to back the non-party political plan that the NHS itself has put together under the leadership of Simon Stevens—the “Five Year Forward View”. We made the big call in our autumn statement to find £2 billion, which is what he said the NHS needed next year, and I hope Labour will support that. Then we can have the kind of consensus that the hon. Lady asked for.

[Paul Uppal (Wolverhampton South West) (Con)]

In 2003, a dozen years almost to the day, I accompanied my grandmother to A and E. We arrived at 8 o’clock in the morning. She was not allocated a bed until 9.30 that evening. May I impress upon my right hon. Friend that money alone is not the issue? It is important that we push ahead with the long-term plan and do not adopt a short-term opportunistic approach.

[Mr Hunt]

My hon. Friend is right. It is important to say that lots of people in the NHS have been asked in the past few days on the media what the issues are, and they have not been saying that it is about money. They have been saying that it is about reforming the structures. That is why, as well as the money that is available for this winter, we need to look at the plans that we can put in place to improve access to GPs, to improve the co-ordination between the health and the social care systems, to deal with issues that prevent people from going to hospital in the first place. That is what this Government want to do.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

Many of my constituents in Feltham and Heston have raised with me their concerns about being able to access GP services, some having to wait weeks and in the mean time having to seek emergency help. Does the Secretary of State now regret the Government’s decision to axe Labour’s guarantee of a GP appointment within 48 hours?

[Mr Hunt]

If the hon. Lady regrets that, she might want to ask her Labour colleagues in Wales why they also axed the 48-hour target. We do need better access to GPs. That is why we are funding the training of 5,000 more GPs over the next five years. With targets, we must be careful of unintended consequences. When we had that target in place, a quarter of people who asked for an appointment in more than two days were told that that would not be possible, because we found that people played the target. That is why we do not want to go back to that system.

[Justin Tomlinson (North Swindon) (Con)]

As set out in the College of Emergency Medicine’s 10-point plan to improve A and E, co-location of GP surgeries is key. Does my right hon. Friend agree?

[Mr Hunt]

I agree with pretty much all the College of Emergency Medicine’s 10-point plan. That has very much informed our approach to helping the NHS over this winter. Co-location of GP surgeries on hospital sites is very helpful, but we also need more proactive care for the most vulnerable older people before they feel the need to go to hospital. That will be at the heart of the changes that we want to see.

[Mr Andy Slaughter (Hammersmith) (Lab)]

The reason that west London now regularly has the worst waiting times for A and E, with up to 50% of patients waiting more than four hours, is a direct result of the Secretary of State’s decision to close the Hammersmith and Central Middlesex A and E four months ago. These are sick people who need A and E, not GP services. We have GP services at those hospitals. What we need is for him to cancel or at least review the downgrading of the A and E departments at Charing Cross and Ealing hospitals to GP-led emergency centres. Will he at least do that?

[Mr Hunt]

I say gently to the hon. Gentleman that if we are to solve the problems in his area and others, we should listen to the doctors about the structures that will work best. The structures that we put in place are the structures that doctors advised us to set up. That is why we are supporting them.

[Mr Peter Bone (Wellingborough) (Con)]

Mrs Bone would like to offer best wishes for the new year to the Secretary of State. The reason she can do this is the excellent health care provided by the NHS in both Kettering general hospital and Northampton general hospital. Locally, the commissioners and the acute hospitals are together working out a plan to deal with accident and emergency. Is not that the way forward?

[Mr Hunt]

Indeed. I pass on my best wishes for the new year to Mrs Bone. Like many people, she has benefited from superb NHS care. A million more people are having operations every year under this Government, and 700,000 more people are being seen within four hours at A and E under this Government.

[Gavin Shuker (Luton South) (Lab/Co-op)]

The NHS is a system, which is why cuts to social care and other parts of the system affect A and E. With that in mind, and with 14 hospitals in a state of emergency, will the Secretary of State review the plans that are in place should a winter crisis of cold weather come along at this very vulnerable point?

[Mr Hunt]

It is interesting that the hon. Gentleman did not want to talk to the House about his own local hospital, which is performing extremely well for A and E. It would be good if more of those on the Opposition Benches talked about the good things that are happening in the NHS, including nine out of 10 people who go to A and E being seen within four hours.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I thank the Secretary of State for the £13.4 million given to Medway Maritime hospital’s A and E department. Will he assure me that everything that can be done is being done to turn around hospitals in special measures such as Medway, which had the seventh highest mortality rate in 2006 yet nothing was done? Will he also join me in paying tribute to all the front-line staff who do a fantastic job at Medway?

[Mr Hunt]

I am happy to do that. One of the things that this Government are most proud of is what we have done to turn around hospitals with entrenched low standards of care following the terrible tragedy at Mid Staffs, with 18 hospitals put into special measures and six of them turned around. Despite all the pressure on me and on this Government to hit targets, we are sending out signals to the system, loud and clear, that targets matter, but not at any cost, and that we do not want corners cut when it comes to patient safety.

[Graham Jones (Hyndburn) (Lab)]

Last weekend at Royal Blackburn hospital’s A and E, which I have been concerned about for quite a while, 18 ambulances were waiting outside. That was revealed not by the NHS but by a whistleblower, who described the situation as “chaos”. Is it happening because there are too many patients putting too much pressure on the NHS or because of mismanagement of the NHS by the Conservatives?

[Mr Hunt]

It is because of unprecedented demand caused by a range of factors. If the hon. Gentleman looks at the facts, he will see an NHS that is treating more people more quickly, with more doctors, more nurses and more operations than ever before. Sometimes, though, as I said yesterday, people on the front line feel that they are running just to stand still because there is so much pressure. That is why the £700 million in our winter plan and the money we are putting in to back the five-year forward view next year are so important.

[Karen Lumley (Redditch) (Con)]

Does my right hon. Friend agree that we should not be playing party politics with the NHS in the way that my opponent in Redditch is by putting out leaflets saying that I am systematically voting against the NHS, but that we should be working together with our trusts and partners in ensuring that we get through this problem, as we are trying to do in Worcestershire?

[Mr Hunt]

I absolutely do agree. Labour Members should talk to some of the front-line NHS workers in their own constituencies, who will tell them that the last thing they want at this time is for the NHS to be a political football.

[Jonathan Ashworth (Leicester South) (Lab)]

The Secretary of State will know that major incident status was declared at Leicester hospitals this week for the seventh time in three months. In the week before Christmas, just 67% of patients at Leicester Royal Infirmary in my constituency were seen within the four-hour target, and clinicians, who are working flat out, expect pressures to increase over the next three months. What is he now going to do to support clinicians in Leicester and get a grip of this situation?

[Mr Hunt]

I am aware of the situation in Leicester. The hospital has had significant space pressures in its emergency department, and a couple of nights ago it had a high in-flow during one night, but it is absolutely on the case in trying to resolve this. What are we doing? We have put in £9.2 million of winter pressures money to make sure that whatever people decide the right solution is, it is not through lack of resources that they cannot do it.

[Chris Skidmore (Kingswood) (Con)]

Last Saturday night, while I was visiting my wife’s family in Leicestershire, my baby daughter suddenly became quite ill. Rather than going to A and E, we rang the 111 service and were quickly referred to Loughborough urgent care centre, where we had fantastic treatment; I pay tribute to the staff. Does this not go to show that we need to prioritise new models of urgent care, as set out in Simon Stevens’s review?

[Mr Hunt]

We absolutely do that. Telephones and the internet provide different ways to get the right advice to people quickly. The 111 service is taking a considerable amount of strain at the moment, and we have put in more money to support it. We are investing a lot more in tele-health and tele-medicine, and a lot more to help GPs who want to give people out-of-hours appointments. In the long run, that is the way we will reduce the kinds of pressures that my hon. Friend talks about.

[Helen Goodman (Bishop Auckland) (Lab)]

Over three years ago, I raised with Ministers problems about the North East ambulance service that had been pointed out to me by the paramedics, but unfortunately they were brushed aside. My constituent, Violet Alliston, had the terrible experience of her partner ringing for an ambulance three times in the course of an hour before the ambulance came. She then died. This is obviously completely unacceptable. Why will not the Secretary of State look again at the resources he is taking out of the North East ambulance service, the skills base of the call handlers, and the triage system?

[Mr Hunt]

I am extremely sorry to hear the story that the hon. Lady talks about, and I know that the NHS will investigate it fully. We are not cutting resources to ambulances, though. We have 2,000 more paramedics than four years ago, and £50 million is being put in this winter. Of course, we need to look very carefully into the particular case that she mentions and make sure that any lessons are learned.

[Several hon. Members]

rose—

[Richard Graham (Gloucester) (Con)]

Thank you, Mr Speaker—I will seize the moment.

Part of the long-term solution is attracting and retaining more nurses. Will my right hon. Friend encourage the National Health Executive to allow the university of Gloucestershire to run pre-registration training courses for nurses so that we can attract and retain more local nurses?

[Mr Hunt]

I am happy to do that, and also to welcome the 80 new nurses in my hon. Friend’s local area over the past four years.

[Andy Sawford (Corby) (Lab/Co-op)]

The Secretary of State will be aware that there are particular issues at Kettering General hospital’s A and E unit. It has improved its performance, but it has been described, to the shock of all the MPs in the area, as the worst seen in the country. We have done an awful lot of work. On Tuesday we are bringing the local health organisations together to the Department. Will he encourage his ministerial colleagues to give the green light to our plan for our area?

[Mr Hunt]

We will look at that very carefully. Of course, anything that can help to relieve pressure on A and E departments is our top priority at the moment.

[Fiona Bruce (Congleton) (Con)]

My constituent, Mr J. Hollinshead, rang Ashfields surgery, Alsager, for an appointment at 8.30 am on 2 January. He was given one for 10.30 am, when his doctor referred him for three tests to be done with the practice nurse at 11.30 am, then on to Leighton hospital for an X-ray, and he was home by 1.30 pm. His response: “How good is that?” Is not that a truer picture of the NHS under this Government than the negative messages coming out from Labour Members?

[Mr Hunt]

I agree that we need to recognise the successes of the NHS, and there are many of those successes. The reason we need to do that—I urge Labour Members to remember this—is that it is very important for the morale of people working in the NHS that we publicly recognise where they are being successful.

[Clive Efford (Eltham) (Lab)]

Is it not true that this Government set out with a plan to close nine out of 31 A and Es in London, including the one at Lewisham, as directed specifically from the Secretary of State’s office? Does he regret that? What state does he think the A and E services in south-east London would be in if he had been successful, in the face of public opposition, in closing that A and E?

[Mr Hunt]

First, as the hon. Gentleman knows perfectly well, there were never any plans to close that A and E, and he should desist from scaremongering about what was happening at Lewisham hospital. He should also remember that when this Government came into office—[Interruption.] The plans—

[Clive Efford]

You idiot—it went to court!

--- Later in debate ---

[Mr Speaker]

I am grateful to the hon. Gentleman for his withdrawal and I note what he says.

[Mr Hunt]

The plans were to continue to have an A and E at Lewisham but to take some of the higher-risk patients to another hospital. Those are the plans that we originally had that have now been changed. What I will say to the hon. Gentleman, though, is that there were problems with South London Healthcare Trust for years and years. This Government dealt with them and sorted them out, and that means that his constituents are getting better care than they otherwise would have done.

[David Morris (Morecambe and Lunesdale) (Con)]

Will my right hon. Friend join me in congratulating the staff at Royal Lancaster Infirmary on meeting their A and E targets in November? Will he also share my revulsion at the Opposition putting out a leaflet saying that there are all kinds of things wrong with the A and E and that it is going to close?

[Mr Hunt]

That is exactly the kind of scaremongering, frankly, that is incredibly demoralising for those who are on the NHS front line right now. I urge Labour Members to think before they start doing things that make a difficult situation even worse.

[Kerry McCarthy (Bristol East) (Lab)]

The South Western ambulance service came close to declaring a major incident on 27 December, and local hospitals warned of unprecedented demand last weekend. What is the Secretary of State doing specifically to help hospitals and the ambulance service in the Bristol and Avon area to survive the winter?

[Mr Hunt]

As I mentioned earlier, I have talked to the chief executive of South Western ambulance service about the particular pressures it has faced, such as the 25% increase in 999 calls. We are doing a lot of things, including helping to recruit more paramedics. We have 40 more paramedics starting for the London ambulance service this month, and we are doing what we can to help the South Western ambulance service as well.

[Stephen Mosley (City of Chester) (Con)]

About a third of the patients attending A and E at the Countess of Chester hospital are from the Welsh side of the border. They choose to go there because they know they will get treated a lot quicker in England than they will in Wales. Why is that the case?

[Mr Hunt]

The main reason is that Labour in Wales chose to cut the NHS budget, whereas in England we chose to protect and increase it.

[Mr David Crausby (Bolton North East) (Lab)]

Before a major incident was declared yesterday morning, 76 patients were awaiting transfer to social care in the Royal Bolton hospital—nearly four wards-full—so when is the Secretary of State going to do something effective about the crisis in social care that is causing mayhem in our accident and emergency department?

[Mr Hunt]

I recognise the pressures that the hon. Gentleman is talking about, but last year, for the first time, the local NHS and the local authority in Bolton sat down together to plan social care for the most vulnerable people—his constituents—who need such joined-up care and have wanted but not had it for so many years. With the better care programme from this April, we will start to see some real improvements.

[Henry Smith (Crawley) (Con)]

In 2005, the Labour Government closed the accident and emergency department at Crawley hospital, but services are now returning to the urgent treatment centre. Does my right hon. Friend believe that such centres play an important part in relieving pressure on emergency services?

[Mr Hunt]

They absolutely do. One thing we must do better is signpost people to the different parts of the NHS, such as walk-in centres, urgent treatment centres, GP surgeries or A and E departments. That is why the 111 service is so important in giving that advice at the earliest possible stage.

[Dr Alan Whitehead (Southampton, Test) (Lab)]

Does the Secretary of State now regret the cuts inflicted on Southampton social care provision—they were draconian, disproportionate and possibly motivated by political football—given that Southampton city council has been unable to support the Southampton general hospital by moving people into social care and away from accident and emergency? Will he have a word with Communities and Local Government Ministers to get that put right?

[Mr Hunt]

If the hon. Gentleman feels strongly about that he might want to talk to the shadow Chancellor, who this week publicly ruled out any extra funding for social care.

[Ben Gummer (Ipswich) (Con)]

I was at Ipswich hospital this morning to talk to the senior clinical team. They have exceeded their targets in A and E—it is the fifth best performing hospital in the country—and they have done so because of their work. Will the Secretary of State congratulate them, and does he regret the politicking that undermines their incredible efforts in the service of my constituents?

[Mr Hunt]

The services that the Ipswich team have been delivering are absolutely brilliant, and I congratulate them. I thank my hon. Friend for his support for their work, which I know is so important for the people of Ipswich.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Secretary of State said that 14 major incidents have been declared. I am told by a senior front-line worker that many hospitals are declaring internal major incidents—they have done so for some time—because that is more politically expedient and does not get into the press. How many internal major incidents have been declared in the past month?

[Mr Hunt]

To my knowledge, over the past few weeks there have been 15 major incidents, including internal ones. Three have now been stood down, making a total of 12 at the moment.

[John Stevenson (Carlisle) (Con)]

The Cumberland infirmary in Carlisle is coping and improving. However, to improve more quickly, it needs to conclude the acquisition by Northumbria Healthcare NHS Foundation Trust as soon as possible. Will the Secretary of State do everything he can to help to achieve that, as I believe it will lead to better health care, both in A and E and generally, in Carlisle?

[Mr Hunt]

I am very sympathetic to my hon. Friend’s view. Indeed, I have spoken to him about it on several occasions. I very much hope that the merger can go ahead as soon as possible.

[Kate Green (Stretford and Urmston) (Lab)]

What is being done to address staff well-being during this exceptionally pressured period? Repeated pressure on A and E—with staff being required, or volunteering, to do extra shifts—does in the end put pressure on staff, and may cause burn-out and risk to patients. What is being done to attend to that issue?

[Mr Hunt]

There are two things. First, as I am sure the hon. Lady does, I take every opportunity to praise the work being done by staff through a very difficult and challenging period. Secondly, the practical way in which we can most help them is to try to recruit more staff where we possibly can, and to make sure that resources are not a barrier to recruiting more staff. We have about 5,000 more nurses in hospitals compared with 12 months ago, and that has made a difference.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Secretary of State stood up and said that he takes personal responsibility for everything that happens in the NHS. Given that his Government undertook a costly and time-consuming reorganisation, does he now regret that people took their eye off the ball in relation to the highly predictable population shifts that have led to the pressure on A and E?

[Mr Hunt]

I am afraid that that is an example of the politicisation of the NHS that people find so distressing. Those reforms were not enacted in Wales, which is run by the hon. Lady’s party, and A and E performance there is significantly worse. It does not make any logical sense to blame A and E performance on those reforms.

[Julie Hilling (Bolton West) (Lab)]

Royal Bolton hospital says that it is in crisis because it cannot discharge patients. The Secretary of State says that the hospital and local authority in Bolton are talking to each other, but Bolton council has had £100 million-worth of cuts. What will he do to reverse the cuts in social care that have created the crisis in our hospital?

[Mr Hunt]

If the hon. Lady is making a criticism, I would ask her what she is going to do, because the shadow Chancellor confirmed this week that he will not find extra money for social care. I will tell her what we are doing. We are merging the social care and local NHS systems to try to stop people being pushed from pillar to post, and to give them the joined-up, compassionate, safe care that we think is an absolute priority. That is happening in Bolton—I have visited facilities in Bolton that are displaying excellent care—and we should support such efforts, not criticise them.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

In January 2013, I raised with the Health Secretary the incident in which an 84-year-old lady had to wait 11 hours for an ambulance. This Christmas, a 101-year-old lady had to wait six hours for an ambulance, and an 89-year-old pensioner also had to wait 11 hours for an ambulance. When do individual incidents of failure become a pattern, and is the Health Secretary himself an individual incident of failure?

[Mr Hunt]

I take huge interest in individual examples of where things have gone wrong, and that has informed a lot of my approach to the job. Just like A and E departments, when ambulance services get calls, they have to triage them and deal with the highest-priority calls quickest. The calls they get can sometimes be dealt with after a period of hours, but other calls are much more urgent. The important thing for ambulance services is to know that we are backing them with more paramedics, more investment and more ambulances, and that is what we are doing.

[Mr Steve Reed (Croydon North) (Lab)]

One of my constituents, an 80-year-old woman, collapsed at home over the weekend. She had to wait an hour for an ambulance to arrive, and she then waited 10 hours in A and E before being treated by medical staff. For most of that time she was on a trolley in a corridor. Will the Secretary of State apologise to my constituent? Does he not regret wasting billions of pounds on a top-down reorganisation of the health service, instead of using the money to fund the additional doctors and nurses who could have treated my constituent and thousands of others like her across the country more quickly?

[Mr Hunt]

Management costs in the NHS doubled under the hon. Gentleman’s Government; under this Government, they have been cut by £1 billion a year, which is paying for 9,000 more doctors and 3,000 more nurses. That is the reality of the NHS under this Government—1 million more people are getting operations every year—and if he really believed in the NHS, he would support and welcome that, rather than criticise it.

UK Ebola Preparedness

Jeremy Hunt Excerpts

Monday 5th January 2015 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Mr Speaker, I would like to make a statement about the UK’s Ebola preparedness and the care being given to Pauline Cafferkey, the NHS nurse being treated for Ebola at the Royal Free hospital in London.

I know the whole House will join me in wishing Pauline well and commending her and her NHS colleagues for the exceptional bravery and compassion they showed in joining the battle against Ebola in Sierra Leone. The work done by Pauline and her colleagues is not just helping to save thousands of lives in Africa; it is protecting the UK from potentially disastrous consequences if the disease spreads beyond the countries where it has currently taken hold. Alongside 69 other NHS volunteers from UK-Med, Pauline spent Christmas on the front line of this vital battle. This House and this country owe them and other colleagues from Public Health England, the Department for International Development, the Foreign Office and the Ministry of Defence an enormous debt of gratitude.

You will appreciate, Mr Speaker, that for reasons of patient confidentiality I cannot go into great detail about Pauline’s current medical condition. However, I have this morning spoken to Dr Mike Jacobs, an expert in infectious diseases who is leading the team of doctors and nurses caring for Pauline at the Royal Free. As has been reported, Pauline’s condition has deteriorated to a critical state, although she stabilised yesterday and continues to receive the best possible care. She said in Sierra Leone that she hoped her loved ones would be proud of her. Well, she should know today that the whole country is proud of her for her bravery and dedication to the service of others. She stands, quite simply, for the very best of NHS values.

I wish to turn to the issue of screening and why Pauline continued her journey from Heathrow to Glasgow. Having worked in Sierra Leone for six weeks caring for Ebola patients, she was screened and cleared to depart on her exit from Sierra Leone on Sunday 28 December. She arrived at Heathrow after a connection in Casablanca at 3.50 pm that day, where she was again screened in line with the protocols introduced into major airports and Eurostar terminals last October. As her temperature was within the acceptable range, she was cleared to fly home to Scotland. Clinical experts have always been clear that the process will pick up a few active infections, but it also provides the best opportunity to ensure that returning staff know whom to contact, and this system worked. While still at Heathrow, her reassessment was triggered because of concerns that she may have had an elevated temperature. She was reassessed and her temperature taken a further six times over 30 minutes. As her temperature was within the acceptable range, she was again cleared to travel.

Pauline arrived in Glasgow at around 11.30 pm on Sunday 28 December and was driven home. She became feverish overnight and, in line with the public health advice that she had been given at Heathrow, she contacted local services. She was admitted to an isolation facility at the Brownlee unit in Gartnavel hospital in Glasgow at 8 am on Monday 29 December. A blood sample tested positive for Ebola at the NHS Lothian testing facility that afternoon, so she was transferred overnight to the Royal Free in a military plane, arriving at 8 am on Tuesday 30 December.

Some have asked whether it was appropriate for Pauline to be allowed to travel on to Glasgow after she raised concerns about her health at Heathrow. The clinical advice on this is clear. Someone can contract Ebola only by coming into contact with the bodily fluids of an infected person—that means blood, vomit or diarrhoea—which becomes a risk when a patient is exhibiting feverish symptoms. Because she did not have a high temperature, the clinical judgment was made to allow her to continue her journey home.

However, we recognise that medical understanding of the disease is not complete, which is why we had already taken a number of precautionary steps that go further than strictly required by the clinical evidence. These include asking potential Ebola carriers to avoid crowded places and long journeys on public transport within the 21-day potential incubation period once they arrive back home. Existing guidance also bans any direct patient work for returning health care workers.

On that precautionary basis, we have, as of last Monday, strengthened our guidance to ensure that anyone from a higher risk group who feels unwell will be reassessed. Advice will immediately be sought from an infectious diseases specialist and the passenger will be referred for testing, if appropriate. The screening centres at Heathrow were viewed at first hand on 1 January by the chief medical officer and the Minister with responsibility for public health and all arrangements, including the revised protocols, were found to be working well.

We will continue to keep screening and logistical arrangements under review and look to improve or strengthen the process, as guided by expert clinical advice. It is important, however, to remember that the risk to the public of contracting Ebola from contact with someone carrying the virus remains very low indeed while they are not exhibiting any symptoms. The critical point—this is the main purpose of the screening—is to ensure that potential Ebola carriers are identified and know how to ask for medical assistance the moment they display any feverish symptoms, so that they can then be isolated, tested and given full medical support as quickly as possible.

For that reason, on a precautionary basis, Public Health England has been making contact with passengers on the flight that Pauline was on from Casablanca to Heathrow, and has been working with Moroccan colleagues to trace additional UK passengers on the flight from Freetown to Casablanca to make sure that they know what to do if they start exhibiting symptoms consistent with Ebola. I can inform the House that Health Protection Scotland has made contact with all the passengers on the London to Glasgow flight, and Public Health England has made contact with all UK-based passengers who travelled on the flight from Casablanca to London. I would like to thank British Airways and Royal Air Maroc for their assistance in this process.

The safety of our volunteers is our first priority. Before any NHS workers are deployed to treatment centres, staff from UK-Med, which runs the NHS humanitarian register, review the clinical protocols and procedures and confirm that they are content that the centre meets appropriate standards. All UK-Med volunteers receive thorough training in the UK and in Sierra Leone before they treat any Ebola patients so that they know how to use their personal protective equipment and understand the nature of the work. In the current case, as the House would expect, Save the Children is conducting a review of its procedures to ensure that any lessons are learned.

The House will want to be reassured about the overall state of UK preparedness for Ebola. This country was the first in Europe to screen arrivals from high-risk places in west Africa, and numerous countries have since asked for information on how we did this. We have committed more than £230 million to fight the disease in Sierra Leone. We have sent more than 800 military personnel, 150 Department for International Development staff, 70 NHS staff through UK-Med and 64 Public Health England staff to fight the outbreak on the ground—a bigger contribution than any country in the world except for the United States.

The chief medical officer, Professor Dame Sally Davies, has always been clear that we are likely to see up to a handful of cases in this country, of which, very sadly, this is the first to be diagnosed. NHS England has procured personal protective equipment for each of the hazardous area response teams in England and has additionally arranged for 75,000 PPE suits to be procured for the NHS.

We have been practising Ebola resilience since 30 July and have had 16 ministerial Cobra meetings in total, including five chaired by the Prime Minister. Both the chief medical officer and the NHS England medical director, Professor Sir Bruce Keogh, are satisfied that at this stage we have made sufficient preparations. However, they stress that, although the risk to the public remains low, we must remain vigilant and be constantly prepared to adjust and improve our processes and protocols as this rapidly changing situation evolves.

I would like to place on record my thanks to colleagues in the Scottish Government and the UK Government, to the authorities in Sierra Leone and Morocco, to NHS England and to the NHS doctors and nurses at both Gartnavel hospital and the Royal Free for their dedication and hard work over the past few days. I would also like to pay tribute to the dedicated PHE staff who set up the new screening process so rapidly, and thank Border Force staff for their assistance.

Our thoughts are with Pauline Cafferkey today, but I know all of us are also thinking about her friends and colleagues and the many UK NHS and other personnel working in Sierra Leone right now. They can be reassured that we have no greater priority than their safety, and I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

Over the break, there have been a number of reports suggesting that the Ebola outbreak is far from under control and we saw, as the Secretary of State has said, the first case diagnosed here in the UK. Concerns are rising and that is why the Secretary of State was right to give his informative update to the House at the very first opportunity.

May I echo the tribute he paid to all the NHS staff, members of the armed forces and aid workers who are showing immense courage in the most difficult of circumstances? In particular, we echo his moving words and good wishes for Pauline Cafferkey. Our thoughts are with her and her family right now, and we know she could not be in better hands than those of the team at the Royal Free.

On the substance of the Secretary of State’s statement, we welcome what he had to say and the action he is taking. As I said the last time he updated the House, we will play a constructive part in helping the Government to minimise the risk to the public. That remains the case and the questions I will put to him—some of which will cover areas he has not mentioned, particularly treatment and vaccine—will be asked in that constructive spirit.

Let me begin with the circumstances surrounding the case. The Secretary of State mentioned the Save the Children review of how Pauline caught the disease. Are the Government part of that review and/or are they carrying out their own, and when will the results be known? He did not mention when it would be published, but that is important as the next group of NHS volunteers will leave for west Africa in the coming weeks. They will want to know whether procedures and guidance for medical staff working out in west Africa will be reviewed in the light of this case.

I would also be grateful if the Secretary of State could tell us whether he is satisfied with current guidance to NHS staff here on handling Ebola patients. He will be aware that the US Centres for Disease Control and Prevention have recently strengthened their infection control guidance, and on the last occasion he updated the House he said he would follow their lead. What revisions, if any, have been made to those protocols following the CDC’s changes?

Let me turn to screening. We know that Pauline travelled to Glasgow via London Heathrow and despite informing screening staff at Heathrow that she felt unwell she was still allowed to fly home. I welcome what the Secretary of State has just said about reviewing procedures for future passengers in a similar position, but there are broader concerns. Martin Deahl, who was part of the same volunteer group as Pauline and sat next to her on the plane home, said:

“The precautions and checks at the airport were shambolic. There seemed to be too few staff and too few rooms or places to put us in. We were crowded into a small reception area where we waited for an hour or more. I had a higher temperature so they wanted to put me in a room by myself—but they could not find one because they were using every inch of space.”

I welcome the Secretary of State’s commitment to keep the arrangements under review, but may I ask him to look into the specific concerns raised by Mr Deahl and to rectify any problems as a matter of urgency, and certainly before the return of the next group of volunteers?

More broadly, is the Secretary of State satisfied that the screening procedure is adequate in terms of the medical checks that are carried out—are more checks needed than just temperature checks—and, indeed, is he satisfied that staff have had sufficient training? Were the Scottish NHS, the Scottish Government and, crucially, Glasgow airport informed that Miss Cafferkey had warned officials that she felt unwell? In the light of this case, should screening checks be expanded to cover more ports? I would be interested in the Secretary of State’s views on those points. I am sure he would agree that maintaining public confidence in the screening procedure is crucial, and I hope he will continue to keep all those questions under review, as he has said he would.

Let me turn to post-arrival monitoring. A number of states in America have introduced it for all travellers returning from an affected country, whereas only those showing symptoms on return are actively monitored here. Given that symptoms of Ebola can emerge up to 21 days after exposure, is there a case for strengthening post-arrival monitoring in line with other countries?

On treatment, we understand that Pauline is receiving an experimental drug, not ZMapp, owing to a worldwide shortage. When the Secretary of State last updated the House, I asked him whether plans were in hand to increase supplies of ZMapp, so the latest news is a matter of concern. Are any efforts under way to increase manufacturing capacity for ZMapp and/or any other potential treatments? Of course, what would give most confidence to people in the countries affected and further afield is the development of an effective vaccine. Will he say something about the timetable for that, and about the Government’s role in trying to expedite it?

More broadly, will the Secretary of State give the House his latest view on the adequacy of the international response to Ebola. We hear that the health system in Sierra Leone is in danger of collapse, immunisation programmes have come to a halt and people are not going to the hospitals or clinics because they are frightened of catching Ebola, and that might lead to the spread of other diseases. Over Christmas, William Pooley said:

“This is a global problem and it will take the world to fix it.”

Does the Secretary of State share that sentiment, and what are the Government doing to bring about a better global response than we have seen to date?

In conclusion, it is clear that Ebola will remain a threat for the foreseeable future, and it will not be easy to meet that challenge. We join the Secretary of State in sending our best wishes to Pauline and her family, and we will continue to work with him and the Government to minimise the risk to others.

[Mr Hunt]

May I first thank the right hon. Gentleman for the constructive tone of his comments and the official Opposition’s willingness to work closely with us on this very important issue? Let me cover some of the important points that he made.

The right hon. Gentleman is right that the disease is continuing to progress in those countries. We now have a total of 7,905 reported deaths, and there are 20,206 reported cases, which is likely to be an underestimate. There are some early—I stress, early—signs that the rate at which the disease is reproducing itself is beginning to fall to about the level where it is stabilising. However, those are early signs, and the truth is that we still need to do a huge amount of work to bring the disease under control.

We think that it is absolutely vital to proceed as quickly as possible with the vaccine that the right hon. Gentleman mentioned, and I can tell him that we currently have three vaccines in the first phase of clinical trials. We have made some changes to speed up the process by which they can be used in the field, and DFID has put in £1.34 million to establish a joint research fund with the Wellcome Trust, so we are making progress on that front.

It has been impossible to get supplies of ZMapp—the drug given to the other Ebola patient treated in the UK, Will Pooley—because it is grown using genetically modified tobacco plants, so there is a time constraint. Clinically, we do not yet know whether it was significant in Will Pooley’s recovery. We have tried other experimental treatments on Pauline Cafferkey, including using some of the plasma from Will Pooley, and we hope that will have an effect.

The review by Save the Children is being conducted in conjunction with Public Health England staff in Sierra Leone, and I hope that it will report in the next few days. We are obviously keen for them to report as quickly as possible, but we do not want to put them under pressure not to do a thorough report. I am satisfied with current protective arrangements on the basis of our clinical evidence, but as we saw with the screening arrangements, with a disease such as Ebola we must constantly keep an open mind about the best ways of dealing with things, and we will look carefully at what Save the Children recommends. I am satisfied with the protections in place for NHS workers in the UK on the basis of advice from the chief medical officer, and we will obviously also look at what happened in the US. At the moment we do not believe that the personal protective equipment suits have been breached, but we must keep an open mind and see what other evidence comes forward.

On the screening procedure, our clinical protocols were followed when Pauline Cafferkey arrived, but organisationally I do not think that it was as smooth as it needed to be. There were a lot of people to deal with, and because it was over the Christmas period we probably did not have as many people to do that as we needed, which meant that those coming for screening needed to wait longer than we would have liked. However, on the basis of revised protocols, and to ensure that we do not repeat this situation—nine more volunteers are coming back this Sunday and 60 more the following Sunday—the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), and the chief medical officer have been to inspect what is happening, to ensure that we learn the necessary lessons. Other volunteers have said that they think the screening procedure is working smoothly. This was a relatively isolated incident, but we must learn the lessons.

On expanding screening to other airports, I will look into whether Glasgow airport was informed and let the right hon. Gentleman know, but we have obviously learned from this event the importance of close working with the Scottish Government, and that has worked very well.

Finally, the right hon. Gentleman mentioned the active monitoring of people who come back, and I think that we have the best system. We are not only actively monitoring those who have been tested for having contracted the disease, but actively monitoring anyone in the high-risk groups. Of the 2,495 people who have been screened since we set up the process, 54 have been identified as having had direct contact with Ebola patients and as being in the high-risk group, and we have an enhanced monitoring process for them. Everyone else is informed exactly what to do if they develop feverish symptoms, which is what happened with Pauline Cafferkey.

I again thank the right hon. Gentleman for his constructive approach to this issue.

[Dr Sarah Wollaston (Totnes) (Con)]

I join the Secretary of State in paying tribute to Pauline Cafferkey and all NHS volunteers, aid workers, staff at DFID and Public Health England for the work they are doing to keep us safe in the UK by fighting Ebola on the front line in west Africa at great personal risk. I also thank him for updating the House so succinctly on the improvements to the screening protocols, so that everyone will be screened if they have symptoms, not just a temperature. Will he update the House on the vaccines and say whether there has been any progress on the provision of rapid screening for Ebola? Will he reassure us that he will not follow the knee-jerk response that we have heard calls for from some quarters, which is to quarantine all NHS staff, because of the unintended consequences of such an approach?

[Mr Hunt]

I thank my hon. Friend for her constructive comments and I agree with what she has said on this issue. Some 678 health care workers have contracted Ebola since the outbreak of the disease, and of those nearly 400 have died, the vast majority African. That shows how incredibly brave front-line workers are, and perhaps the fact that—tragically—we have someone in this country who has contracted Ebola is a good way of reminding ourselves that many hundreds of other people have already been in this situation. They are all incredibly brave. We are proceeding as quickly as we can with the possibility of having a much speedier Ebola test, which would obviously be helpful for the screening process.

I agree with my hon. Friend that we do not want a knee-jerk response on quarantining people who come back. The contribution of NHS volunteers and health care workers from western countries in fighting the disease in Sierra Leone, Guinea and Liberia is critical. Some 1,500 people from the NHS have volunteered, but they volunteer on the basis that we will follow proper clinical protocols, meaning quarantining people when it is clinically necessary to do so, but not doing so when it is not necessary. If we are to keep their confidence, we must be proportionate in our response.

[Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)]

Pauline Cafferkey is a constituent of mine and works at Blantyre health centre in my constituency. I have spoken to a number of those whom she has treated and her colleagues over the past few days. I am sure the House will appreciate that there is a huge amount of support and concern for her locally, but also a huge admiration for her work in Sierra Leone as an NHS volunteer. I am sure that that is shared by communities throughout the UK, with the exception of a small handful of people who should keep their opinions to themselves.

On the Secretary of State’s concerns about the screening process, when an experienced clinician describes a process as shambolic, it is not only about the protocol, but about the practicalities. As well as keeping the matter under review, will he ensure constant monitoring each weekend as people come back to ensure that the practicalities are properly kept in check, to ensure that the situation that seemed to happen last Sunday is not repeated?

--- Later in debate ---

[Mr Hunt]

I echo the hon. Gentleman’s comments about what a remarkable lady Pauline Cafferkey is. When she was asked why she was going, she said, “Why wouldn’t you go when so much suffering is happening in west Africa?” That is the measure of the woman.

On the screening process, I am satisfied that the right clinical processes were followed, but I am not satisfied that it was as well organised as it should have been. That is why we have revised not just the clinical protocols, but the organisation, to ensure that we have the right capacity in place, and that we do not make people wait for as long as they did when Pauline returned on her flight. It is also important to recognise that the Public Health England staff at Heathrow are working very hard doing a difficult job, and are doing their very best.

[Mr David Heath (Somerton and Frome) (LD)]

I commend the federal and state authorities in Nigeria for the work they did in containing the Ebola outbreak there last year. In the space of a four-day visit, I had my temperature taken 34 times—whenever one goes into a public building, one has one’s temperature taken. Everyone who visits a Nigerian airport has to fill out a form giving details of where they have been and where they are going, contact details, and details of where they sat on the plane. Is the Secretary of State confident that he has the same level of traceability in this country as the Nigerian authorities have achieved in their country?

[Mr Hunt]

Yes, I am. I join the hon. Gentleman in commending the actions of the Nigerian authorities. What has happened in Nigeria in respect of Ebola shows a great deal of hope for what is changing in Africa more generally. There was a perception that all African countries would find it as challenging to deal with Ebola as Sierra Leone, Liberia and Guinea have found it, but it is clear that a generation of African countries have developed substantially and are able to respond in a much more effective way. That is a very encouraging change from what might have been the case 10 or 20 years ago.

[Frank Dobson (Holborn and St Pancras) (Lab)]

I thank the Secretary of State for his statement. I am in no position whatever to comment on the effectiveness of the screening and suspect that no one else in the Chamber is. On long-term preparedness, it is several decades since Peter Piot, now director of the London School of Hygiene and Tropical Medicine, first identified Ebola. Worldwide, not enough has been done to address the problems. We should not be looking for a vaccine now; it should have been looked for years ago. I hope the Secretary of State gives full support to the rare disease consortium that has been established by the London School of Hygiene and Tropical Medicine, Imperial college and the Royal Veterinary College to look at infectious diseases that are capable of crossing from one species to another, and in particular this species.

[Mr Hunt]

The right hon. Gentleman is absolutely right. Peter Piot is a remarkable man who came to Downing street to advise the Prime Minister and me early in the development of the Ebola crisis. He is well worth listening to on this subject.

The right hon. Gentleman also makes a good point in that the global response to Ebola was far from adequate. The World Health Organisation has some important lessons to learn, and tomorrow my right hon. Friend the Secretary of State for International Development and I will meet Margaret Chan, when we will no doubt talk about those lessons. In an era of globalised travel, it is important that we have a much faster and more effective response when we have outbreaks of deadly viruses.

[Sarah Newton (Truro and Falmouth) (Con)]

Will my right hon. Friend join me in thanking the staff of the Royal Cornwall hospital who treated someone returning from Sierra Leone with great professionalism, caring and compassion? Will he reassure me and those staff that, as well as those arriving back from west Africa by plane or train, those arriving back into our ports by ship are effectively screened?

[Mr Hunt]

I am happy to pass on my thanks to the staff of the Royal Cornwall—in fact, I spoke to someone from that hospital this morning and I know that they are very focused on this issue, as are all NHS hospitals. We have introduced information at all ports and, where necessary, screening. My hon. Friend makes an important point—it is never actually possible to put every single person through a screening process. We are one of the most open economies in the world and people constantly come in and out of the UK. We depend on public knowledge, so that people who have been to the affected areas know to present themselves to get immediate assistance if they develop any feverish symptoms.

[Mr Peter Hain (Neath) (Lab)]

Has the Secretary of State had the chance to consult the British Medical Journal editorial of 13 October, which insisted—more than two months ago—that the Government’s airport screening policy for Ebola was illogical? I spoke to the author yesterday and he argues that we have missed the one case to have been imported while thousands, many at low risk, have been delayed, detained and made to fill in a form just because they have been to west Africa. Experts such as the author insist that what the Government should have been doing is ensuring that all those at risk, especially health workers such as Pauline, know exactly what to do if they start to feel unwell. Might it be sensible to keep health workers away from direct patient contact for 21 days after they return?

[Mr Hunt]

Perhaps I can reassure the right hon. Gentleman on that point. Health care workers are kept away from direct patient work for that incubation period, so that protocol has been put in place. The BMJ article to which he refers is based, I think, on the misunderstanding that screening is the same as testing. The reality is that the tests for Ebola show up only when the virus has reached a certain level, at which point the patient will have become feverish and started displaying symptoms, so testing before that point is a waste of time. The purpose of the screening process is to identify those at highest risk so that we can make sure that they are actively monitored when they go home and that they know exactly what to do if they do develop symptoms. That is exactly what happened with Pauline Cafferkey.

[Andrew Bridgen (North West Leicestershire) (Con)]

There is a saying that when it rains everyone’s roof gets wet. That is apt in the case of Ebola which, as we have heard, poses a global threat. Does my right hon. Friend agree that the best way to protect the British people from the Ebola outbreak is to continue to actively support international efforts to eradicate it in west Africa itself?

[Mr Hunt]

My hon. Friend is right. The most important thing we can do is to eliminate this disease at source, and that is why we can be extremely proud of the efforts of DFID and my right hon. Friend the Secretary of State. As I have said, we are the country that is doing the second most in the entire world to combat the disease in west Africa. There is no better example of the link between proper development policy abroad and security at home.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

May I thank the Secretary of State for his statement, affording as it does an opportunity for the House to pay tribute not only to Nurse Cafferkey and all the other NHS volunteers, but the staff of the Royal Free hospital in my constituency who day in, day out demonstrate all that is best in our NHS? When the Secretary of State meets the World Health Organisation tomorrow, will he highlight a most recent report that states that, although it is possible there has been a diminution in urban areas in west Africa, rural areas in west Africa are still giving great cause for concern? There seems to be no overarching co-ordinated work in those particularly difficult areas. Will he also, as the United Kingdom was the first off the blocks to offer services to sufferers of Ebola, act as some kind of needle to the other countries in the international community that are still failing to help in the fight against this potential catastrophe?

[Mr Hunt]

The hon. Lady is absolutely right that we need all countries to play their part. We have been very involved in international efforts to try to ensure that other countries, particularly in Europe, play their part as we in the UK have been doing. I commend her constituents who work at the Royal Free for their remarkable work, which really is world beating and incredibly impressive. It is also very challenging. The situation that Pauline is in is very difficult for them to cope with, but they are doing so with the highest levels of professionalism. On rural areas, DFID has been focused from the start on how to ramp up community care in rural areas. She is right to say that that is a very important priority.

[Mr Philip Hollobone (Kettering) (Con)]

I thank the Secretary of State for the tone and content of his statement. Nevertheless, I think my constituents in Kettering would have two concerns about the Pauline Cafferkey incident. First, what my constituents do not understand is why, when this health worker reported feeling unwell, caution was not prioritised and she was not tested before travelling, as we now know on a crowded underground train into the centre of London. Secondly, I understand that she travelled back to this country with quite a large number of other health workers. When an airport knows that a large number of health workers are about to descend on it, why are resources not in place to deal with quite a large number of people all in one go?

[Mr Hunt]

We have learned the lessons to speed up the process so that people, I trust, will not have to wait as long. One of the lessons we learned in the Christmas period is that we do not want people to have to wait as long. I want to stress to my hon. Friend—perhaps he could stress this to his constituents—that the clinical risk of contracting Ebola from sitting next to someone who is not exhibiting feverish symptoms is very low. That is why the clinical advice was, and remains, that it is perfectly safe for someone to travel on a train if they are not displaying the symptoms. We want to go further, however. We recognise that we do not know everything about this disease and therefore want to be precautionary. That is why we have said that if people in the high-risk categories—those who have had contact with Ebola patients—say they are unwell, we will have a different protocol going forward even if their temperature is within the normal range. I hope that will reassure his constituents.

[Keith Vaz (Leicester East) (Lab)]

The Government were absolutely right to start screening on 14 October. May I urge the Secretary of State to resist calls from those who say that screening is not effective and should stop? This was not a direct flight: it went through Casablanca. Although we have put a lot of resources into Sierra Leone and we have resources at Heathrow, there appears to be no international effort in the major hubs in Africa. What steps are going to be taken to help Governments such as that in Morocco, specifically in Casablanca, which receives so many flights from other countries in Africa that end up at Heathrow airport?

[Mr Hunt]

I thank the right hon. Gentleman for raising that point; he has done so on a number of occasions. It is very important that there is not a weak link in the chain. We have been relatively satisfied with the screening procedures at Casablanca, which we have obviously inquired into in great detail because of the fact that Pauline came through Casablanca, but I will ask Public Health England to reassure me that it is satisfied with those screening procedures, and, if not, if there is any assistance we can provide to the Moroccan authorities.

[Jeremy Lefroy (Stafford) (Con)]

I thank my right hon. Friend for paying tribute not only to the British defence, NHS, Public Health England and DFID workers, but to the immense courage of Sierra Leonean, Liberian, Guinean and Nigerian health workers, as well as many others. As he said, several hundred have paid the ultimate price for their devotion to their patients. The right hon. Member for Leigh (Andy Burnham) mentioned the health system in Sierra Leone. Will the Secretary of State, along with my right hon. Friend the Secretary of State for International Development, ensure that as much help as possible is given to the Sierra Leonean Government to strengthen their health system and avoid a collapse that could pose a great risk to the UK?

[Mr Hunt]

I can reassure my hon. Friend that my right hon. Friend the International Development Secretary has spoken to the President of Sierra Leone about that very issue. One of the big learning points from the relative success of Nigeria, which we discussed earlier, in combating Ebola compared with Sierra Leone has been about the strength of the local health system. One particular challenge is that the entire health system in Sierra Leone is now focused on Ebola, raising the risk of other diseases, such as malaria, tuberculosis and HIV, killing more people even than Ebola. Strong local health care systems are an important long-term insurance policy to ensure that countries can deal with infectious diseases.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

We are still learning about Ebola and the efficacy of the screening processes. What discussions has the Secretary of State had with other European countries, particularly European Health Ministers, to share best practice, exchange what we have learned and ensure a comprehensive approach?

[Mr Hunt]

I have spoken to several European Health Ministers, and the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for public health, is in regular touch with them about the international effort. The hon. Lady is right that no one country can solve this on its own, and we collaborate well with others—perhaps most closely with the French, who have taken responsibility for the fight against Ebola in Guinea.

[Martin Horwood (Cheltenham) (LD)]

I declare an interest, as my wife worked for Public Health England. I am sure that all PHE staff will appreciate the Secretary of State’s calm and supportive words today.

Local directors of public health have traditionally formed part of the response to such incidents, not least in reassuring the general public—perhaps the hon. Member for Kettering (Mr Hollobone) as well—so is the Secretary of State confident that they still have the resources and organisational support to do this effectively now that they are part of local government, not the NHS?

[Mr Hunt]

To date, no issues have been raised about resourcing for those very important responsibilities, but we will keep an eye on that. Every local area has had a resilience exercise to ensure it is prepared for what happens if someone contracts Ebola in its area, and so far we have been satisfied with the response, but obviously we will keep it under review.

[Mr Frank Roy (Motherwell and Wishaw) (Lab)]

I understand the constraints on the availability of the ZMapp drug to fight Ebola, but is the Secretary of State really telling the House that there is nothing the Government can do to minimise those constraints?

[Mr Hunt]

If we could buy it, we would, but there is no availability internationally, and we are waiting for more supplies. We are using other experimental treatments on Pauline, and it is important to stress that we do not know whether ZMapp actually worked, but we want to do absolutely everything we can.

[Margot James (Stourbridge) (Con)]

I wholeheartedly support my right hon. Friend’s comments about the bravery of Pauline Cafferkey and the other health and military workers fighting Ebola in Sierra Leone. Their sacrifice and bravery humble us all. Will he confirm that the Government will continue to follow medical advice and keep a sense of perspective regarding the real threat of contagion when monitoring and setting screening policies here in the UK?

--- Later in debate ---

[Mr Hunt]

Yes, I can absolutely confirm that, and I thank my hon. Friend for raising the point. It is important to say that this is not an exact science, because we do not know everything about the disease, so a balance sometimes has to be struck, but I think my discussions with Professor Paul Cosford and the chief medical officer have brought us to the right place: we follow the clear clinical guidelines, but where there is a precautionary extra step we think would be sensible in the circumstances, we take that as well.

[Stewart Hosie (Dundee East) (SNP)]

I place on record my thanks for the work done by Pauline Cafferkey and her colleagues and express my sympathy for the predicament in which she finds herself. I would like to thank the Secretary of State, too, for what he said about continuing to keep screening arrangements under review and looking to improve them on the basis of expert clinical advice. If recommendations emerge quickly for improvements to, or an expansion of, screening, will he move equally quickly to put those recommendations into place?

[Mr Hunt]

I can absolutely give the hon. Gentleman that assurance. When we have decided to change protocols, they have been changed within hours, not within days.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Pauline Cafferkey is a heroine and the thoughts of the whole House are with her and her family at this difficult time. Many people will be glad that the Secretary of State mentioned the hundreds of African health workers who have died fighting Ebola, showing extraordinary heroism and devotion to duty. Our constituents, including those linked to families in that region, will want to know that we will continue to give the region all the support we can in fighting Ebola long after it has dropped from the headlines.

[Mr Hunt]

I could not agree more with the hon. Lady. Some 382 health care workers have died of Ebola, and it is worth saying that they include not just local people from Sierra Leone, Liberia and Guinea, but people from all over Africa as well as small numbers from other parts of the world. The very least we can do is to continue to support an aid budget, which will allow them to continue to improve their local health care systems.

[Barry Gardiner (Brent North) (Lab)]

The Prime Minister said over the weekend that those displaying symptoms at Heathrow would be referred straight to Northwick Park hospital in my constituency because the isolation units are based there. Those isolation units are, however, strictly limited—I think there were only six at the last count—so can the Secretary of State advise us whether back-up facilities will be put in place? Given the nature of this disease, six isolation may prove inadequate.

[Mr Hunt]

I would like to reassure the hon. Gentleman that isolation facilities are available at other London hospitals. The ones he mentioned happen to be the closest, so they are the ones we would use first. Let me briefly clarify that it has always been the case that if someone showed any symptoms, we would isolate them and put them into quarantine. The change in protocol I am announcing today—we enacted it last week, but I wanted to report it to the House at the earliest opportunity—will mean that even if someone is not displaying the symptoms but says that they are feeling a bit under the weather, they will be isolated if they are in the high-risk category.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

It is somewhat ironic that only a couple of days before Christmas, I wrote to the Prime Minister saying that we should fully recognise all the volunteers who leave this country to do this excellent, selfless work, putting themselves in danger—and here we are today discussing the case of Pauline Cafferkey. Everyone’s thoughts are with Pauline and her friends and family.

I am led to believe that any problem should be dealt with at source, and there is still great concern about the amount of contaminated material, medical waste and contaminated protective equipment that is perhaps not being dealt with properly at source—being buried rather than incinerated, for example. I contacted the office of Professor Dame Sally Davies, and was told to write to her. I did so last week, asking her to look at finding a means of disposing of waste in a far better manner. So far, I have not had word back from her, but I am sure the Secretary of State will want to take this matter on board and ensure that it is dealt with better at the source of the infection.

[Mr Hunt]

To clarify the question, I think the hon. Gentleman is talking about how waste is disposed of in Sierra Leone, as we are satisfied with the way in which it is disposed of in the UK.

[Mr Brown]

indicated assent.

[Mr Hunt]

That being the case, I will ask the Secretary of State for International Development to write to the hon. Gentleman with her assessment of how satisfactorily that process is handled in Sierra Leone.

[Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)]

Will the Secretary of State tell us more about the support given across all Departments in finding treatments for Ebola, including support for the current trials being conducted by the Institute of Infection and Global Health at Liverpool university under Professor Tom Solomon?

[Mr Hunt]

We are giving strong support to that important work. Our support is being led in the Cabinet Office by my right hon. Friend the Minister for Government Policy and Chancellor of the Duchy of Lancaster, who is bringing together all the Departments that can provide it. The sooner we can obtain a vaccine or a treatment that works, the better, and this could prove to be a very important part of the process of turning the tide.

A and E and Ambulance Services

Jeremy Hunt Excerpts

Thursday 18th December 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the performance of accident and emergency departments and ambulance services, and what plans are in place to help them cope with winter pressures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I welcome this opportunity to come to the House and confirm NHS plans to support A and E and ambulance services over the challenging winter period. First, we must recognise the context. The NHS always faces significant pressures during the winter months, and with an ageing population we have 350,000 more over-75s than four years ago. As a result, more people are turning up at our A and Es, with attendances up 5% on last year, and a greater level of sickness among those who turn up has led to an increase in emergency admissions of nearly 6% on last year. That picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland, as well as England, missing key performance standards as a result.

In England, where performance has been relatively better than in other home nations, we have been preparing for this winter for more than nine months—indeed, I chaired my first meeting to discuss the issue on 17 March. On 13 June we gave the NHS an additional £400 million for winter pressures. That was topped up in autumn by £300 million, making a total of £700 million to ensure that local services had the certainty of additional money and time to plan how it should best be used. That funding was provided earlier than ever before in NHS history, and was possible because a strong economy has allowed us to make year-on-year real-term increases in NHS spending. That funding will pay for the equivalent of 1,000 more doctors, 2,000 more nurses, and 2,000 other NHS and care staff, including physiotherapists and social workers. It will fund up to 2,500 additional beds in the acute and community sectors, and provide £50 million to support ambulance services.

We are also progressing with a long-term plan to reduce pressures on A and E. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, and more than 4 million people are already benefiting from that. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. The Five Year Forward View is funded by an additional £2 billion of new money announced in the autumn statement—we have a long-term plan for our NHS, just as we do for the economy.

The winter will be tough, but a number of changes made over the last four years will put us in a much stronger position. Since 2010, the NHS has nearly 1,200 more A and E doctors, including 400 more consultants, almost 600 more registrars, 1,700 more paramedics and 17,200 more clinical staff overall. Our A and E departments are seeing and treating around 2,000 more people within four hours every day, and our ambulances are making nearly 2,000 additional emergency journeys every day. The Care Quality Commission has confirmed that compassionate care in A and Es has improved over the last two years, and according to patients the NHS is getting record scores for the safety of care, and for treating people with dignity and compassion.

I will conclude by thanking hard-working NHS staff across the country for the outstanding care that they continue to deliver under a great deal of operational pressure. On behalf of the whole House I also thank the 70 NHS front-line volunteers who will be making this country safer by spending their Christmas in Sierra Leone on the front line in the fight against Ebola. They are the bravest of the brave and make our entire country proud.

[Andy Burnham]

I thank the Secretary of State for his statement. I of course echo the sentiments he expressed about NHS staff and volunteers fighting Ebola.

I have to say, however, that I heard a good deal of misplaced complacency in what he had to say. Winter has not begun in earnest, but there are already signs of A and Es and ambulance services being stretched to the limit. Last week, a record number of people waited more than four hours in A and E and on trolleys. Ambulance response times are getting worse across England, with some 999 calls taking hours. Overnight, news has emerged of an 82-year-old man who waited more than three hours for an ambulance to arrive at his nursing home. He then waited a further 19 hours on a trolley in a corridor. That is appalling, and there are fears that things will get worse when the House is in recess.

Given that, it should not be for me to drag the Secretary of State here today to explain what he is doing to prevent a full winter crisis in the NHS. The question he did not answer, but must answer today, is this: does he have a winter plan? If he does, will he publish it? People working in the NHS need to know what is in it. [Interruption.] He seems to suggest that he has one, but let me quote Dr Mark Porter, chair of the British Medical Association. He criticises what he calls the

“total failure by government to come up with a meaningful plan”.

The Secretary of State will have to reassure Dr Porter.

The Secretary of State mentions money, but is it not the case that £300 million of it was allocated only in November? Does he really think that that gave the service enough time to plan? Dr Clifford Mann, chair of the College of Emergency Medicine, does not think so. He says:

“Had these funds been used back in summer and early autumn we might have more resilience in the system now.”

Dr Mann also questions where this money has gone, saying “very little” has been seen by front-line A and E staff, and instead

“a lot of it has gone to shoring up balance sheets in acute trusts”.

Is that true? Will the Secretary of State provide of full breakdown of how that money was allocated and has been spent to date? Were any conditions attached? I am sure he will claim the money has been used properly, but, if that is the case, why is the NHS already under so much pressure?

Over the break, hon. Members will want to monitor the situation in their local hospitals very closely. However, we have learnt that from tomorrow the publication of data on A and E will be suspended for three weeks over the crucial Christmas period. That is simply unacceptable. Given that we know the figures are still being collected, there is absolutely no reason why they should not be published. The Secretary of State rightly puts a premium on transparency. Will he today order an end to the news blackout and instruct NHS England to maintain weekly reports?

I have visited a number of acute trusts in recent days and they all say that the pressure on A and E is critically linked to the severe shortage of places in nursing and residential homes and cuts to social care. The sad truth is that today a record number of older people are trapped in hospital. They are well enough to go home, but do not have the support to do so. When are the Government going to wake up to the very real crisis in social care and the fact that it is dragging down the NHS?

Finally, no one can predict what this winter will hold, but the warning signs are there and the NHS needs to plan for all eventualities. What discussions has the Secretary of State held with other Departments, and do the Government have a wider contingency plan for the NHS?

This is a serious situation. If patients and staff are to have confidence, they need better answers than they have had so far. I hope the Secretary of State will start providing them now.

[Mr Hunt]

First, may I thank the shadow Health Secretary for bringing this matter to the attention of the House? As a former Health Secretary, he knows that operational pressures are one of the biggest challenges facing any Health Secretary. Indeed, he had many examples of very, very poor care on his own watch and he is absolutely right to give the House a chance to hear more about our plans for winter.

The shadow Secretary of State asks whether we have a plan. It seems to me that he prepared his comments before he listened to the statement. We have put in more money than ever before. Plans were announced in June. NHS England had a press conference in which it went through the plans relating not just to the £400 million, but the extra £300 million that was agreed in September and allocated through October. That is a record amount. Let us consider what is happening in his own constituency. In Wigan borough, since 2010, because of spending that he opposed, Wrightington, Wigan and Leigh NHS Foundation Trust has taken on 78 more doctors, 149 more nurses and 209 more clinical—[Interruption.] He says, “Does this help?” These are extra doctors and nurses on the front line, helping patients in his own constituency.

The right hon. Gentleman talked about care homes. The £3.3 million going to help his own constituents with winter pressures is to monitor the mental and physical health of patients in care homes and to help reduce the number of emergency admissions. We have a winter plan that is working in his own constituency to help improve the lot of his constituents. He needs to acknowledge that.

The right hon. Gentleman talked about the publication of figures over Christmas. We have never published figures over the Christmas period because it would mean forcing NHS staff to work over Christmas, whereas, where possible, we would like them to be able to go home for Christmas, just like Members of this House. When he was Health Secretary, did he publish performance or weekly A and E figures over Christmas? He did not. He did not publish them at Christmas or Easter; he did not publish any weekly A and E figures at all, so to come to the House and call it a news blackout says to me that he is more interested in political opportunism than in care for patients.

It is disappointing that the right hon. Gentleman did not take this opportunity to disown his own leader’s instructions to weaponise the NHS. The NHS is not, and never should be, a political weapon. This is what third parties say. Dr Mann, president of the College of Emergency Medicine, whom the shadow Secretary of State mentioned, said yesterday that

“the system is under pressure but it’s working pretty well”.

The Foundation Trust Network said:

“NHS providers prepared for this Winter earlier and more fully than ever before”

and that—he should listen to this bit—the

“NHS needs support not criticism”

please. The NHS Confederation said the NHS was pulling out all the stops on urgent care and A and E, and that earlier planning and extra money were helping.

The right hon. Gentleman wants to draw comparisons. Nine out of 10 people are being seen within four hours in this country, which is a higher proportion than in any country anywhere in the world that measures A and E performance—faster than Australia, New Zealand, Canada, Scotland, Northern Ireland and, yes, faster than Labour-run Wales. Eight people out of every 100 wait more than four hours in A and E in England; in Wales, that figure is 15 hours. He should concentrate on saving the NHS in Wales, rather than running it down in England, where it is doing so much better.

Finally, if the right hon. Gentleman is worried about poor care, why is he still saying it was wrong to have a public inquiry into Mid Staffs? This is what Julie Bailey, the Mid Staffs campaigner, said this week about his comments:

“It is very worrying, because if he becomes Health Secretary again at the election it is clear we would go straight back to the old days of covering up.”

The NHS is performing well under great pressure. He should commend the efforts being made by front-line staff, not undermine them by trying to turn the NHS into a political football.

[Mr Simon Burns (Chelmsford) (Con)]

Will my right hon. Friend join me in congratulating the staff of Broomfield hospital in Chelmsford and the GP surgeries in mid-Essex on the fantastic job they are doing to look after patients in difficult circumstances because of the significant increase in the number of patients needing and accessing care? Furthermore, does he agree that it is rather demoralising for staff and sad that Labour seeks to turn the NHS into a party political football simply—

[Mr Speaker]

Order. The Secretary of State does not need to concern himself with Opposition policy, as I think the right hon. Member for Chelmsford (Mr Burns), on his good days, knows. The Secretary of State should focus on a brief statement of the Government’s policy, for which we will be grateful.

[Mr Hunt]

I can confirm that the Government’s policy is to root out poor care wherever we find it, not to cover it up and conceal it for party political purposes.

[Valerie Vaz (Walsall South) (Lab)]

The College of Emergency Medicine gave the Secretary of State a 10-point plan in 2013. Will he say which of those 10 points he has enacted?

[Mr Hunt]

We have enacted, or started to enact, every single one of them. Some of them take a bit longer—the contracts for A and E consultants, for example, which we want to ensure are attractive enough to encourage people to want to become A and E consultants. I am pleased to say that we have made some progress on that and are now getting the recruits coming into A and E that we want to see. Other things are starting to happen this winter—more co-location of GP services at A and E front doors and better discharging procedures from hospitals. We have been working very closely with the College of Emergency Medicine, which has been a great help to us in devising these winter plans.

[Mr Mark Hoban (Fareham) (Con)]

Last Friday, my hon. Friends the Members for Portsmouth North (Penny Mordaunt) and for East Hampshire (Damian Hinds) and I met leaders of the health and social care system in south-east Hampshire to discuss how it is dealing with the operational challenges it faces. May I commend to my right hon. Friend the model it is using—of working together to prevent unnecessary admissions, ensuring a safe and speedy assessment of those who turn up at A and E and also issuing a prompt discharge of those who are medically fit to return to their own homes?

[Mr Hunt]

My hon. Friend is absolutely right, and I commend what is happening in his constituency. He will be pleased to know that this is beginning to happen all over the country. The heart of the long-term solution is to have people in the social care system, people in primary care and people in hospitals to see themselves as part of one system, in which people are properly flowing between different parts of the system in the way that is right for them, ignoring organisational or institutional barriers. Where that happens, we are making good progress and we are getting the right performance in A and Es.

[Ms Karen Buck (Westminster North) (Lab)]

Last week, the chief executive of Imperial College Healthcare NHS Trust told me that it had a ward of patients that it was unable to discharge into the community. This week the Care Quality Commission ranked the A and E unit at St Mary’s as being inadequate owing to a lack of bed capacity and physical capacity in the ward. Yesterday the London ambulance service had to call in emergency help because it is under such pressure. What is the Secretary of State doing to turn around the crisis in central London’s health service? Will he remind us again why it made sense to close two west London A and E units in the middle of an A and E crisis?

[Mr Hunt]

It is funny how the hon. Lady talks about the closing of A and E departments without talking about the opening of A and E departments and the improvement of facilities. The plans for north-west London involve significant improvements, including weekend opening of GP surgeries, which is one of the key things that the shadow Front-Bench team has talked about as something that will help A and E departments. As for what is happening specifically, I was disappointed with the CQC report about the A and E at St Mary’s, but I gently say to her that it was this Government who set up an independent inspection regime with a chief inspector who gives the public information in a way that they did not have before. I think that is the biggest spur to making sure that the right changes are made quickly.

[Sir Bob Russell (Colchester) (LD)]

The general public will not have been impressed with the political posturing from the shadow Secretary of State. Does my right hon. Friend agree that a significant number of people who go to A and E should not be there, and as part of his long-term NHS planning, does he agree that if first aid were taught as part of the national curriculum, fewer people would go to A and E?

[Mr Hunt]

I commend my hon. Friend for championing this cause. He is absolutely right that we need first aid. I think that my hon. Friend the Member for Brigg and Goole (Andrew Percy)—I am not sure he is here—is a first responder, and I want to commend him for the work he does in that respect, because it makes a big difference in emergency situations if we can people to patients more quickly.

[Mr Andy Slaughter (Hammersmith) (Lab)]

The CQC report into Imperial, to which my hon. Friend the Member for Westminster North (Ms Buck) referred, found poor standards of cleanliness, too few nurses and thousands of patients awaiting surgery. It is the third CQC report in west London in four months, and it has found five major hospitals as requiring improvement and three A and E departments inadequate. The only one that is not inadequate—Charing Cross, which is good—is the one the Secretary of State wants to close. Waiting times are down to some of the worst in the country, yet they used to be among the best. We in west London do not recognise what he is saying. After two years of refusing, will he now meet me and other west London MPs to talk about the crisis in west London health care?

[Mr Hunt]

On the contrary, it is the hon. Gentleman’s constituents who do not recognise what he says or all the scaremongering leaflets about what is happening to NHS services in north-west London. We have plans to open two brand-new hospitals; we have weekend opening of GP surgeries; and we have big improvements happening in A and E departments. Let me gently say to him that, along with his Front-Bench team, he voted not to have a chief inspector of hospitals who could provide independent information about the quality of services. Now that he is quoting that information, I hope he realises that that was a mistake.

[Sir Tony Baldry (Banbury) (Con)]

Clinical commissioning groups and hospital trusts throughout the country, including those in Oxfordshire, are working very hard to ensure that they can triage people at the entrance to accident and emergency departments, so that those who need primary care get primary care and those who need A and E services get A and E services. Was the urgent question not simply a new form of political ambulance-chasing?

[Mr Hunt]

What my right hon. Friend has said about what is happening in Oxfordshire is very important. I commend the efforts that are being made there, as well as those that are being made in so many other parts of the country. It is interesting to note that all the questions that are being asked by those on the Government Benches are about the details of how we can help the NHS to get through the winter, while on the Opposition Benches it is all about politics. I think we know which side cares about patients the most.

[Douglas Carswell (Clacton) (UKIP)]

There have been serious problems with ambulance response times in Clacton. I recognise that the ambulance trust is addressing some of them, and I recognise that the Secretary of State is taking genuine steps, not least in establishing proper inspection systems, which is fantastic. However, many of the problems have been connected with turnaround times at Colchester hospital’s A and E department. Would it not be helpful if patients could access primary care via GPs in the first place rather than being forced to go to A and E departments? Emergency care would be then accessible in emergencies.

[Mr Hunt]

The long-term solution is to provide more GPs and GP capacity, which is why we plan to train 5,000 more GPs over the course of the next Parliament, but that will take time, so we need to find shorter-term solutions. We are working with the Royal College of General Practitioners to establish what can be done in the short and medium term.

[Mr David Nuttall (Bury North) (Con)]

Does my right hon. Friend agree that hoax calls are one of the causes of the pressures on the ambulance service, and that those responsible should always be prosecuted and dealt with in the most severe manner possible?

[Mr Hunt]

It is totally unacceptable for people to create extra pressure on ambulance services when they should not be doing so. One of the encouraging aspects of the better care programme is the fact that we are starting to analyse the ambulance service, the local NHS and the social care system in order to establish where the highest volumes of ambulance calls are coming from and sort out the problem.

[Mr Clive Betts (Sheffield South East) (Lab)]

Two weeks ago, along with other Members of Parliament, I met executives of the Sheffield Teaching Hospitals NHS Foundation Trust, which, as I am sure the Secretary of State agrees, is an outstanding trust that invariably meets its care and financial targets. However, we were told that even that trust was not meeting its A and E targets. Would the Secretary of State care to reflect on the fact that if a trust as good as the Sheffield Teaching Hospitals trust is experiencing those problems now, there is a real prospect of crisis in the NHS this winter?

[Mr Hunt]

I agree that that is an excellent hospital, and I commend the leadership of Sir Andrew Cash, its chief executive. I have been to the hospital myself; it was absolutely spotless, and I was very impressed by what I saw.

The hon. Gentleman is right. What we cannot do, given the pressures faced by the NHS, is start pointing fingers at individual hospitals, because even well-run hospitals are experiencing a high level of pressure. Hospitals tell us that the solution is often not in their own hands. It is a question of the number of people who turn up at the front door and the number of people whom they are able to discharge at the back, and if neither of those problems is sorted out—which will require proper links with the rest of the local NHS—there will be further problems. The system resilience groups that are now working throughout the country are trying to deal with the issue.

[Sir Peter Bottomley (Worthing West) (Con)]

I praise the clinical and other staff at Worthing and Swandean hospitals, and at Rustington’s Zachary Merton hospital. Could hospitals and GPs in each region or locality get together with care homes and nursing homes and establish, with the help of paramedics and members of the ambulance service, which people should be taken to hospital and which people should remain at the nursing or care homes? Too often, people in old age are taken to hospital when that is inappropriate.

[Mr Hunt]

My hon. Friend is absolutely right. I commend the care at Worthing hospital. As he will know, I try to go out on the NHS front line and take part in a shift most weeks, and the very first hospital I went to was Worthing hospital, where I thought the care was excellent. He is right that it is about close working; people in care homes who end up going to A and Es when they could have been better looked after at their care home is probably top of the list of admissions to hospital that we could avoid, because we know the vast majority of those people will end up being admitted to hospital if they arrive at an A and E. That is often not the best thing for people with late-stage dementia, for example, so my hon. Friend is absolutely right and I want to reassure him that that is a big focus of our efforts this winter.

[Kate Green (Stretford and Urmston) (Lab)]

Mrs J, an elderly constituent of mine, waited two hours following a fall for an ambulance that should have reached her in 30 minutes. The Secretary of State will be aware that there have been similar cases, not least the one described to the Deputy Prime Minister by my hon. Friend the Member for Bolton West (Julie Hilling) at Prime Minister’s questions last week. Two calls were made to the North West ambulance service in respect of Mrs J, and one was received from NWAS one and a half hours after the first report, explaining there would be a delay in getting an ambulance to her because of pressures in the system. While it is welcome that the family and carers were kept informed about what was going on, is it not a symptom of terrible pressures in the system that routine operating procedures now have to include call-backs to explain delays?

[Mr Hunt]

The hon. Lady is right, and there is particular pressure in the ambulance service across the country. We are putting in £50 million of winter-pressures money to help address those issues. Where there are unavoidable delays because of other emergencies at the same time, it is important to get the communication right, and I do not think we do that as well as we should. There are times when we could give more specific information about the likely arrival times of ambulances, according to the algorithms used by 999 and 111 call-handlers. That would keep the public better informed. That is something we are looking at.

[Jeremy Lefroy (Stafford) (Con)]

West midlands ambulance paramedics and staff do a brilliant job under great pressure at the moment, but one thing that the head of the ambulance service has mentioned to me is the difficulty in planning ahead to provide more vehicles and staff because some of the funding—not particularly the winter-pressures funding, but funding around Stafford hospital—is on a short-term recurring, rather than a long-term, basis. Might the Secretary of State look into that and see how it could be made long term, so that instead of paying lots of overtime, we could recruit and train more paramedics?

[Mr Hunt]

My hon. Friend is absolutely right to draw attention to that issue. One issue that has been debated often in this House is the money we waste in the NHS on locum staff, who are much more expensive than full-time staff. One of the ways we can deal with that is through something I announced in my response to the extra money in the autumn statement on our long-term plan for the NHS, which is to give multi-year commissioning contracts and multi-year tariffs to trusts, so that they can have a longer-term horizon. Too often the planning horizon is just for the next year. Indeed, I think there is a discussion to be had about whether this winter pressures money we put in every year to help could be better integrated in NHS core budgets, as a way of making sure we get the best use of that money.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

North-East ambulance service is now the eighth out of 10 ambulance services to be moved to operational level 4 as a result of winter pressures—while temperatures are 12° C and above. In my area, the local hospital trust is £91 million in deficit and the Government have gone into a process of closing minor injuries units in Guisborough hospital and Brotton hospital and walk-in centres in Skelton and Park End. Does the Health Secretary believe any of those factors might be adding to winter pressures, or am I just scaremongering and being political?

[Mr Hunt]

If the hon. Gentleman looks at the facts, rather than being political, he will see that in his constituency there are more doctors and nurses and more front-line clinical staff than there were, and he will find that more people are getting operations and more people are being seen at A and E departments than when his party was in power. That is why, I am afraid, it is very political. I notice that on the day when the Labour party is saying that there is a big issue with winter pressures in the NHS, fewer than 10 Labour Back Benchers are present—fewer than 10; that is how seriously Labour is interested in this issue. Is it not really about the politics?

[Dr Matthew Offord (Hendon) (Con)]

Having accompanied the London ambulance service on a shift at the Mill Hill depot in my constituency, I have seen the unrealistic demands placed on the ambulance service. Fiona Moore, the medical director of the London ambulance service, has said that more than 6,000 calls were made in the capital over the Christmas period last year in connection with alcohol-related incidents. Does the Secretary of State agree that that is unacceptable and that it places an unfair burden on the service?

[Mr Hunt]

I do. I thank my hon. Friend for going out with his local ambulance service. Indeed, I want to thank the many Members on both sides of the House who go out and see what is happening on the NHS front line. The problem that my hon. Friend raises is exactly the kind of problem we are trying to address. I do not want to pretend that all these problems can be addressed this winter. Part of the issue is that the quickest way to see a doctor is to go to A and E, where the average waiting time to see a doctor is only half an hour across the country. That is the fastest time anywhere in the world. We need to find better out-of-hospital alternatives, and better alternatives to calling an ambulance, if we are to reduce the pressure on the emergency services.

[Kerry McCarthy (Bristol East) (Lab)]

It was reported recently that Bristol’s Southmead hospital was the third worst performing hospital in the country on emergency targets, with only 84% of cases seen within four hours. NHS England temporarily withheld £1.35 million to cope with extra winter demand while a believable improvement plan was produced. Clearly, 84% is nowhere near acceptable, particularly as we approach winter. What can the Department of Health do to ensure that Southmead hospital improves its performance?

[Mr Hunt]

We are doing a number of things. I have spoken to people in the Bristol area about what we need to do to improve the situation there and I assure the hon. Lady that we are focusing on it. It is partly why we are putting in £700 million this year to help hospitals to cope with those pressures. We have a brand-new hospital in Bristol as well, and it has had some teething problems, but I am confident that the staff there are working incredibly hard to turn the situation around.

[Charlie Elphicke (Dover) (Con)]

In Dover, we are looking at ways of reducing the pressure on A and E through the Prime Minister’s “8 till 8” challenge fund, and at upgrading the minor injuries unit to create a local emergency centre. Is that not a more fruitful thing to do than simply revelling in the winter problems in the NHS, as the Opposition have been doing?

[Mr Hunt]

My hon. Friend is right. The NHS wants to know that it has a Government who have a long-term plan for the NHS, who are prepared to fund that plan and who have thought about the long-term solutions. Better access to GPs is one of the key things, as is access to a GP who actually knows about the patient and their condition. Sadly, we lost named GPs following the changes to the GP contract in 2004, but I am proud to say that, from next April, we will be bringing them back.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Secretary of State has accused Opposition Members of political scaremongering. Perhaps I should refer him to the Public Accounts Committee’s report on out-of-hours services, which showed cost-shunting to the ambulance service by out-of-hours providers, and to our recent hearing on A and E, which revealed an incredible waste of public money and a lack of joined-up thinking. That is not scaremongering; those are facts from the National Audit Office being interpreted by Members from all parties.

[Mr Hunt]

Yes, and those are the facts that we are acting on with our winter plans. We are trying to reduce the amount of money spent on locum staff and to increase flow going into and out of A and E departments. There is a huge amount of practical things that can be done. I have absolutely no problem with dealing with constructive suggestions from both sides of the House on how we can help A and E departments to get through a difficult winter. It is unacceptable, however, constantly to turn this issue into a political football, when everyone knows that the pressures of an ageing population are making life very difficult for NHS staff and that those staff have a Government who are doing everything they can to support them.

[Nigel Mills (Amber Valley) (Con)]

I welcome the extra money for the NHS this winter, but what more can the Secretary of State do to improve awareness of and confidence in the 111 system, in order to stop people going to A and E when they do not really need to do so?

[Mr Hunt]

My hon. Friend asks an important question. The 111 service is one of the elements of the long-term solution that we have not touched on much this morning. There are definitely things that we can do to make the service better. For example, if someone is put through to a GP, that GP could, with the patient’s permission, access their medical records. That would give the GP access to information about the patient’s allergies, their medication history and other key information that would help the GP to give better advice. I am pleased to hear from NHS England that, by the end of this year, a third of 111 centres will be able to access GP records with the patient’s permission.

[Robert Jenrick (Newark) (Con)]

Will the Secretary of State join me in praising the Fosse Way first responders and the staff of the East Midlands ambulance service, whom I will be going out with over the Christmas period? The East Midlands ambulance service has its problems, with the last Care Quality Commission report finding it was failing on four of the six major measures, and any support he can give the service will be much appreciated by its new leadership. Does he agree that Nottinghamshire residents will be surprised to hear of the Opposition spokesman’s interest in ambulance services, given that we in Nottinghamshire trace the failings of our service directly back to the last Labour Government’s decision to regionalise the ambulances services, which took an excellent ambulance service down to a failing one within five years?

[Mr Hunt]

Interestingly, the Opposition, who are trying to make so much of this, have actually run out of questions in an urgent question on a matter that they said was very urgent. I commend my hon. Friend’s interest in the east of England and I reassure him that we discuss it most weeks in my Department, because two of my ministerial colleagues are covered by the east of England ambulance service and we are very conscious of the problems there. The situation is getting better but there is a long way to go.

[Andrew George (St Ives) (LD)]

My right hon. Friend is fully aware, because he attended the Health Committee last week, that accident and emergency services do not operate in isolation. So does he not agree that integrating not only in-hours and out-of-hours GPs, NHS 111, ambulances services and minor injuries units, but social services, mental health services and dental services is essential to ensure that we have fewer avoidable A and E admissions and that we therefore reduce the pressure we are debating today?

[Mr Hunt]

I do agree. The first thing we could do as a step towards that is properly integrate out-of-hours care, linking out-of-hours GP services, A and E departments and 111 departments. Obviously, that needs to be linked into the in-hours GP care that people will give. I wish to commend the efforts being made in Cornwall to improve A and E performance, which has been getting better in recent weeks. We are all very encouraged by that, because there have been a lot of challenges in that area.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I thank the Secretary of State for the personal support he has given to Medway Maritime hospital, particularly the extra £5.5 million given to the hospital to improve its A and E services. Will he confirm that hospitals in special measures and in challenging circumstances will receive any additional resources they need over the coming winter months?

[Mr Hunt]

We absolutely will make sure that we give Medway what it needs. I wish to thank my hon. Friend for his tireless campaigning to improve the situation, as it is very challenging there at the moment and he has taken a responsible attitude towards it. It is really important to praise the staff at the hospital, who are working very hard, and to reassure his constituents that although there are many improvement to be made, there is a lot of excellent care in that hospital and we all want to get there as quickly as we can.

[Mark Pawsey (Rugby) (Con)]

When I visited the A and E department of the University Hospitals Coventry and Warwickshire NHS Trust in Coventry, I saw some hard-working, dedicated staff dealing with many patients who had chosen to be there, rather than making an appointment with their GP, because that was easier and more accessible. Does the Secretary of State agree that much of the challenge of getting to see a GP arises from the GP contract negotiated by the previous Government?

[Mr Hunt]

We know that there were some serious problems in that contract. Interestingly, the hon. Member for St Ives (Andrew George) was talking about integrated care, but we used to have named GPs who were responsible for the entirety of someone’s care—the GP’s name was on that person’s medical record. That was abolished in 2004, which was a very big mistake—we absolutely want to put it right.

[Martin Vickers (Cleethorpes) (Con)]

When the Opposition use the NHS for political point scoring it can undermine the efforts of staff and cause unnecessary anxiety to constituents. A previous example of that was on 26 November when at Prime Minister’s questions it was suggested that Scunthorpe general hospital was turning away emergency cases, which was not the case. That necessitated the shadow Secretary of State’s office ringing the chief executive to clarify the situation. Will my right hon. Friend take this opportunity to thank the staff at Scunthorpe’s hospital and reassure my constituents that it is open for business?

[Mr Hunt]

I am happy to do that. Staff will have been extremely disappointed at the efforts of the Labour party to try to turn into some sort of political football the services that they offer under a lot of pressure and with much hard work. Members of the public just need to look at the Chamber right now, and they will see which party believes in the NHS and which party does not.

[Mr Robin Walker (Worcester) (Con)]

Tomorrow I will be visiting the Worcestershire Royal hospital, part of the Worcestershire Acute Hospitals Trust, in which there are 144 more nurses, midwives and health visitors as a result of investment by this Government. Hospital staff tell me that winter pressures are added to by the number of long-term dementia patients who are staying on wards. Does my right hon. Friend agree that we need to keep increasing investment in that area to ensure that we get better dementia care?

[Mr Hunt]

My hon. Friend is absolutely right. One of the most heartbreaking things is to see someone with advanced dementia arriving in an A and E department. People do not know anything about their medical history and the best care that they need, and it becomes very difficult for the hospital to discharge them in that situation. Having proper personalised care wrapped around those individuals will normally mean that hospital is not the best place for them to go. Indeed, to echo the comments that have already been made, the key to that is knowing where they would like to die. Very often it is not hospital, so we need to be much better in that regard.

[Geoffrey Clifton-Brown (The Cotswolds) (Con)]

Will my right hon. Friend examine the discharge situation in Gloucestershire Royal hospital? We had an instance this week of which he may be aware of clinically fit patients not being able to be discharged. We have some excellent community hospitals in Gloucestershire. Will his Department examine that problem to ensure that all branches of the NHS—the acute trust, the care services trust and the commissioning group—work closely together to avoid that problem becoming a real issue in the new year?

[Mr Hunt]

I thank my hon. Friend for championing care for his constituents. Let me reassure him: I had a meeting on that very issue on Monday. It is important that the NHS community care sector plays its role alongside the social care sector in making effective discharge possible.

[Andrew Percy (Brigg and Goole) (Con)]

I thank the Secretary of State for his kind words about first responders. I will be on duty tonight, as will thousands of first responders in Yorkshire ambulance service, Lincolnshire ambulance service and throughout the country, responding to cardiac arrest, respiratory disease and so on. On the matter of community service, what are the Government doing in the light of the Royal College of Nursing saying to us at a Health Committee a few weeks ago that a failure to invest properly in community services 10 to 15 years ago is having a major impact now on our hospitals?

[Mr Hunt]

My hon. Friend is right about that. Just as this Government have taken a very robust attitude towards poor care in hospitals—we now have 6,000 more nurses on our hospital wards following the Francis report—we need to take an equally robust attitude towards what is provided in people’s homes, to make sure that we have proper care. It is a false economy to cut back on out-of-hospital care to pay for hospital care, as we need both.

[Martin Horwood (Cheltenham) (LD)]

rose—

--- Later in debate ---

[Martin Horwood]

Mr Speaker, your festive generosity equals only that of Father Christmas.

Gloucestershire hospitals have been under severe pressure in recent days, but is not one complicating factor that, in Gloucestershire and elsewhere, every unplanned GP admission to hospital goes via the emergency department? Although such cases may be relatively urgent, they are not necessarily what most of us would understand as an accident or an emergency.

[Mr Hunt]

The hon. Gentleman is absolutely right to make that point. There has been a lot of support for the NHS today from Liberal Democrats. If they are ever considering which is the best partner to back the NHS at any hypothetical time in the future, they should know that there is only one party that can provide the strong economy to fund a strong NHS.

[Paul Burstow]

My compliments of the season to you, Mr Speaker.

May I draw attention to the fact that people with mental health problems have double the attendance rates in accident and emergency departments compared with the general population? Given that fact, is it not strange that successive Governments have not invested in the evidence? If we invest in liaison psychiatry, we can reduce the numbers needing to go to A and E and give them better results as well. Is it not time that this Government did that and did it even more than they are planning to do?

[Mr Hunt]

Yes, my right hon. Friend is absolutely right. I can reassure him that we are investing more in liaison psychiatry both this year and next year. The Minister of State, my right hon. Friend the Member for North Norfolk (Norman Lamb), has particularly championed that, as it is a very good way in which to reduce pressure on A and E departments.

Mandate to NHS England

Jeremy Hunt Excerpts

Friday 5th December 2014 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today the Government have laid before Parliament the updated mandate to NHS England for 2014-15.

Our mandate reflects the Government’s focus on getting the best health outcomes for patients, by empowering clinical commissioning groups, health and wellbeing boards and local providers of services.

We are making a non-recurrent increase to the revenue budget for NHS England for 2014-15, and a slight reallocation of resource from capital to revenue. A revision to the current mandate has been laid before Parliament today reflecting these changes to the budget only.

This week’s autumn statement set out the Government’s plans to invest significant additional funding in the NHS. This funding recognises the rising pressures on the NHS and the investment required to support the plans set out in the “Five Year Forward View”.

The additional funding for NHS England for 2015-16 will be confirmed in the revised 2015-16 mandate to NHS England which will be published shortly.

The updated mandate for 2014-15 is attached. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Attachments:

1. The Mandate (The_Mandate.pdf)

Attachments can be viewed online at http://www.parliament. uk/business/publications/written-questions-answers-statements/written-statement/Commons/2014-12-05/HCWS65/ .